Twiddler's syndrome

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Twiddler's syndrome

Twiddler's syndrome is a rare but serious complication associated with the use of implantable medical devices, such as pacemakers and implantable cardioverter-defibrillators (ICDs). This condition occurs when a patient manipulates or "twiddles" the device, leading to displacement or malfunction of the leads.

Presentation

Patients with Twiddler's syndrome may present with symptoms of device malfunction, such as syncope, dizziness, or palpitations. The physical manipulation of the device can cause the leads to dislodge from their intended position, resulting in ineffective pacing or defibrillation.

Diagnosis

Diagnosis of Twiddler's syndrome typically involves a combination of patient history, physical examination, and imaging studies. Chest X-ray or fluoroscopy can reveal the abnormal position of the leads. Additionally, interrogation of the device can show abnormal lead parameters or lack of appropriate device function.

Management

Management of Twiddler's syndrome involves educating the patient about the importance of not manipulating the device. Surgical intervention may be required to reposition the leads and secure the device more effectively. In some cases, a different device placement technique may be employed to prevent recurrence.

Prevention

Preventive measures include thorough patient education and the use of secure device implantation techniques. Ensuring that the device is anchored properly can reduce the risk of Twiddler's syndrome.

Related Pages

• Pacemaker
• Implantable cardioverter-defibrillator
• Syncope
• Dizziness
• Palpitations