Twiddler syndrome occurs when a patient manipulates (rotates) a subcutaneous chest device to the point of detaching and retracting the distal portion of the device.
It is most commonly seen with implanted cardiac pacemakers or implantable cardiac defibrillators (ICDs). With continued rotation, the leads of these devices eventually wrap around the subcutaneous portion of the device.
It can be suggested when the leads on a previously well-positioned device retract and begin to wrap around the subcutaneous portion of the device.
Treatment and prognosis
If it occurs with a pacemaker, then the detached leads render the device non-functional and would need to be revised by the cardiologist.
History and etymology
First described in 1968 as "pacemaker-twiddler's syndrome" referring to a case of permanent malfunction of a pacemaker due to the patient's manipulation ("twiddling") of the pulse generator box 4,5.
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- 2. Liang JJ, Fenstad ER. Twiddler's syndrome. Lancet. 2013;382 (9909): e47. doi:10.1016/S0140-6736(13)61419-1 - Pubmed citation
- 3. Burney K, Burchard F, Papouchado M et-al. Cardiac pacing systems and implantable cardiac defibrillators (ICDs): a radiological perspective of equipment, anatomy and complications. Clin Radiol. 2004;59 (8): 699-708. doi:10.1016/j.crad.2004.01.009 - Pubmed citation
- 4. Bayliss CE, Beanlands DS, Baird RJ. The pacemaker-twiddler's syndrome: a new complication of implantable transvenous pacemakers. Can Med Assoc J 1968;99:371-373
- 5. Nicholson, William J., Tuohy, Kathryn A., Tilkemeier, Peter. Twiddler's Syndrome. New England Journal of Medicine. 2003;348(17):1726-1727. doi:10.1056/nejm200304243481722 (2009) doi:10.1056/nejm200304243481722