Twiddler's syndrome


  • Implantable devices with attached wires traveling remotely are at risk for this complication.
  • Device moves within subcutaneous pocket acting like fishing rod pulling wires back to the "pole."
  • Wires dislodged from appropriate location in myocardium, often by patient 'twiddling' a recently-implanted pacemaker.

Clinical Features

  • Pacemaker placed with poor function.
  • Can present with syncope from lack of pacemaker function.
  • Can present with symptoms related to stimulation of other structures (diaphragm, brachial plexus) as wires migrate from expected position.

Differential Diagnosis

  • Lead separation
  • Lead dislodgment
  • Lead infection


Wrapped pacemaker lead showing Twiddler's syndrome.
Wrapped pacemaker lead showing Twiddler's syndrome.
  • CXR to evaluate the placement of the leads


  • Cardiologist for device/lead placement


  • Admit to allow for device intervention as pacemaker does not function in Twiddler's Syndrome

See Also

External Links