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Pacemaker Twiddler Syndrome

  • CPT Jonathan Zygowiec , Jimmy Tam Huy Pham and Scott Smithgall
Published/Copyright: May 1, 2017
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 117 Issue 5

Keywords: pacemaker; pacemaker twiddler syndrome; twiddler's syndrome

An 80-year-old woman presented to the emergency department with syncopal episodes and fatigue for several hours. The patient had a history of bradycardia-tachycardia syndrome after the placement of a pacemaker in 2003. The patient reported dizziness, nausea, and mild, nonexertional shortness of breath for several days. She denied intentionally manipulating her pacemaker. Plain film radiograph of her chest showed that the pulse generator header of her pacemaker had rotated, and the leads were coiled and retracted (image). Pacemaker twiddler syndrome was diagnosed. The patient was admitted to the hospital and underwent a surgical procedure to replace the leads. No complications occurred.

Twiddler's syndrome is caused by spontaneous, inadvertent, or deliberate manipulation of implantable devices resulting in lead dislodgement and permanent malfunction of the device.1 Retraction of the electrodes may cause phrenic nerve stimulation resulting in diaphragmatic stimulation and a sensation of abdominal pulsations.1 Implantable cardioverter-defibrillators, spinal cord stimulators, and chemotherapy infusion pumps have been involved in cases of twiddler's syndrome.2 Most cases are diagnosed within the first year of device implantation.3 Elderly and obese patients may be at an increased risk for twiddler's syndrome because of loose subcutaneous tissue, which allows for easier rotation.3

From the Department of Emergency Medicine at the Henry Ford Wyandotte Hospital in Michigan (Dr Zygowiec); the Department of Internal Medicine at Garden City Hospital in Michigan (Dr Pham); and the Department of Emergency Medicine at the Riverside Medical Center in Kankakee, Illinois (Dr Smithgall).
Financial Disclosures: None reported.
Support: None reported.
Disclaimer: The views expressed herein are those of the authors and do not reflect the official policy of the Department of the Air Force Reserve, the Department of Defense, or the US Government.

*Address correspondence to CPT Jonathan Zygowiec, DO, MPH, Department of Emergency Medicine, Henry Ford Wyandotte Hospital, 2333 Biddle Ave, Wyandotte, MI 48192-4668. E-mail:

References

1. Bayliss CE , BeanlandsDS, BairdRJ. The pacemaker-twiddler's syndrome: a new complication of implantable transvenous pacemakers. Can Med Assoc J. 1968;99(8):371-373.Search in Google Scholar

2. Al-Mahfoudh R , ChanY, ChongHP, FarahJO. Twiddler's syndrome in spinal cord stimulation. Acta Neurochir (Wien). 2016;158(1):147-154. doi:10.1007/s00701-015-2627-xSearch in Google Scholar PubMed PubMed Central

3. Castillo R , CavusogluE. Twiddler's syndrome: an interesting cause of pacemaker failure. Cardiology. 2006;105(2):119-121.10.1159/000090213Search in Google Scholar PubMed

Received: 2016-07-16
Accepted: 2016-10-17
Published Online: 2017-05-01
Published in Print: 2017-05-01

© 2017 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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  1. EDITORIAL
  2. 10.7556/jaoa.2017.049
  3. LETTERS TO THE EDITOR
  4. Osteopathic Manipulative Treatment During the Third Trimester of Pregnancy
  5. RESPONSE
  6. Response
  7. CORRECTION
  8. Correction
  9. AOA COMMUNICATION
  10. Official Call: 2017 Annual Business Meeting of the American Osteopathic Association
  11. ORIGINAL CONTRIBUTION
  12. Employer-Funded Complete Health Improvement Program: Preliminary Results of Biomarker Changes
  13. EVIDENCE-BASED CLINICAL REVIEW
  14. Vitamin D Deficiency, Its Role in Health and Disease, and Current Supplementation Recommendations
  15. CLINICAL PRACTICE
  16. An Osteopathic Approach to Chronic Pain Management
  17. MEDICAL EDUCATION
  18. Preparing Physicians for Rural-Based Primary Care Practice: A Preliminary Evaluation of Rural Training Initiatives at OSU-COM
  19. SPECIAL COMMUNICATION
  20. Introducing High School Students to Careers in Osteopathic Medicine
  21. THE SOMATIC CONNECTION
  22. Cardiorespiratory Benefit of Aerobic Exercise for Patients With Asthma
  23. Cost-Effective Management of Low Back and Joint Pain by Specialty
  24. Benefit of OMT in Patients Who Underwent Heart Surgery
  25. Addition of Osteopathic Visceral Manipulation to OMT for Low Back Pain Decreases Pain and Increases Quality of Life
  26. Effectiveness of OMT and OCMM for Temporomandibular Disorders
  27. Noninvasive Interventions Efficacious in Reducing Symptoms of Low Back Pain
  28. The Fundamental Frequency: A New Approach to Concussion Diagnosis in Children
  29. CLINICAL IMAGES
  30. Pacemaker Twiddler Syndrome
  31. Retroperitoneal Fibrosis
https://doi.org/10.7556/jaoa.2017.066
Keywords for this article
pacemaker; pacemaker twiddler syndrome; twiddler's syndrome
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. EDITORIAL
  2. 10.7556/jaoa.2017.049
  3. LETTERS TO THE EDITOR
  4. Osteopathic Manipulative Treatment During the Third Trimester of Pregnancy
  5. RESPONSE
  6. Response
  7. CORRECTION
  8. Correction
  9. AOA COMMUNICATION
  10. Official Call: 2017 Annual Business Meeting of the American Osteopathic Association
  11. ORIGINAL CONTRIBUTION
  12. Employer-Funded Complete Health Improvement Program: Preliminary Results of Biomarker Changes
  13. EVIDENCE-BASED CLINICAL REVIEW
  14. Vitamin D Deficiency, Its Role in Health and Disease, and Current Supplementation Recommendations
  15. CLINICAL PRACTICE
  16. An Osteopathic Approach to Chronic Pain Management
  17. MEDICAL EDUCATION
  18. Preparing Physicians for Rural-Based Primary Care Practice: A Preliminary Evaluation of Rural Training Initiatives at OSU-COM
  19. SPECIAL COMMUNICATION
  20. Introducing High School Students to Careers in Osteopathic Medicine
  21. THE SOMATIC CONNECTION
  22. Cardiorespiratory Benefit of Aerobic Exercise for Patients With Asthma
  23. Cost-Effective Management of Low Back and Joint Pain by Specialty
  24. Benefit of OMT in Patients Who Underwent Heart Surgery
  25. Addition of Osteopathic Visceral Manipulation to OMT for Low Back Pain Decreases Pain and Increases Quality of Life
  26. Effectiveness of OMT and OCMM for Temporomandibular Disorders
  27. Noninvasive Interventions Efficacious in Reducing Symptoms of Low Back Pain
  28. The Fundamental Frequency: A New Approach to Concussion Diagnosis in Children
  29. CLINICAL IMAGES
  30. Pacemaker Twiddler Syndrome
  31. Retroperitoneal Fibrosis
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