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Twiddler's Syndrome


  • 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