- Rare occurrence
- Due to shape and weight of pacemakers
today
- Subconscious, inadvertent or deliberate
rotation of pacemaker in its subcutaneous pocket
- Older women may be at particular risk
- Loose subcutaneous tissue
- Lead retracts and begins to wrap around
the pacemaker itself
- Dislodging lead from endocardium and
causing
- Malfunction of device
- Pacemaker may begin to stimulate
diaphragm, vagus or phrenic nerve, pectoral muscles or
brachial plexus
- Imaging findings
- Chest x-ray shows looping of wires
around pacer
- Retraction and change in position of tip
if wire or catheter
- May result in sudden cardiac arrest due to
conduction disturbances
- Also occurs with automatic implantable
cardiac defibrillators (AICDs)
Twiddler's Syndrome-frontal
chest radiograph in top photo demonstrates pacemaker lead
extending into right ventricle (blue arrows); bottom photo, one year
later, shows wire lead is wound around pacer and tip of
ventricular lead has retracted into the left subclavian vein (red circle)
Click here
for same photo without arrows
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