Twiddler's syndrome

Twiddler's syndrome
Chest radiograph showing twiddler's syndrome. The leads of the automated external defibrillator are wrapped around the device and can't be seen in the ventricle.
Specialty	Cardiology

Twiddler's syndrome is a malfunction of a

Twiddler's syndrome presents with a range of symptoms, contingent on the extent of entanglement, the electrode's subsequent retraction, and the final location of the dislodged lead.[3] Leads that become more dislodged up can activate the ipsilateral phrenic nerves, which can result in hiccups, involuntary breathing spasms, or diaphragmatic contractions.^[1][4] The brachial plexus is stimulated by additional coiling and withdrawal of the lead, which causes regular arm twitches.^[5]

Causes

Patient "twiddling," or manipulation, of the pulse generator within its skin pocket results in the device's painless dislodgment; lead dislodgement follows, eventually leading to

The condition's risk factors include being a woman, being obese, belonging to an older age group, having cognitive impairments, and having an implanted device that is smaller than its pocket.^[7][4][8] A related increase in subcutaneous tissue laxity, especially in older patients, makes it easier for the device to become dislodged.^[6][7] Furthermore, the newer devices' smaller sizes make it easy for them to rotate inside the skin pocket.^[3]

Diagnosis

Given its speed and ability to provide a clear image of the lead coiling and device rotation, the chest X-ray is the most straightforward and important diagnostic tool for Twiddler's syndrome.^[3]

Treatment

Repositioning the pulse generator, implanting a new lead, and uncoiling the lead are among the treatments for diagnosed cases.^[4][8][5]

References