- 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.
- 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.
- Lead separation
- Lead dislodgment
- Lead infection
- 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