Twiddler's syndrome: Difference between revisions
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*Device moves within subcutaneous pocket pulling wires back to device with intentional or unintentional movements. | *Device moves within subcutaneous pocket pulling wires back to device with intentional or unintentional movements. | ||
*Wires dislodged from intended location in myocardium. | *Wires dislodged from intended location in myocardium. | ||
[[File:Twiddler Syndrome.png|thumb|Twiddler Syndrome after large pocket and pacemaker wires spinning on themselves]] | |||
==Clinical Features== | ==Clinical Features== | ||
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*Lead separation | *Lead separation | ||
*Lead dislodgment | *Lead dislodgment | ||
*Lead infection | *Lead infection | ||
*Lead fracture | |||
==Diagnosis== | ==Diagnosis== | ||
*CXR to evaluate the lead location | *CXR to evaluate the lead location | ||
==Management== | ==Management== | ||
*Cardiologist for device/lead placement | *Cardiologist for device/lead placement | ||
==Disposition== | ==Disposition== | ||
*Admit for device revision | *Admit for device revision | ||
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==See Also== | ==See Also== | ||
*[[Pacemaker complication]] | *[[Pacemaker complication]] | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Cards]] | |||
Revision as of 20:27, 10 August 2015
Background
- Implantable devices with attached wires traveling remotely are at risk.
- Device moves within subcutaneous pocket pulling wires back to device with intentional or unintentional movements.
- Wires dislodged from intended location in myocardium.
Clinical Features
- Pacemaker placed with poor function.
- Can present with syncope from lack of pacemaker function.[1]
- 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
- Lead fracture
Diagnosis
- CXR to evaluate the lead location
Management
- Cardiologist for device/lead placement
Disposition
- Admit for device revision
See Also
External Links
References
- ↑ Annals of Emergency Medicine, Volume 65, Frizell AW et al, A Peculiar Pacemaker Problem, Copyright Elsevier 2015.