Twiddler's syndrome

Background

• 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 intended location in myocardium.

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

Diagnosis

• CXR to evaluate the lead location
  

  Twiddler Syndrome after large pocket and pacemaker wires spinning on themselves

Management

• Cardiologist for device/lead placement

Disposition

• Admit for device revision

See Also

• Pacemaker complication