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Twiddler's syndrome
From WikEM
Contents
Background
- Implantable devices with attached wires traveling remotely are at risk for this complication.
- Device moves within subcutaneous pocket acting like fishing rod pulling wires back to the "pole."
- Wires dislodged from appropriate location in myocardium.
Clinical Features
- Pacemaker placed with poor function.
- Can present with syncope from lack of pacemaker function.
- Can present with symptoms related to stimulation of other structures (diaphragm, brachial plexus) as wires migrate from expected position.
Differential Diagnosis
- Lead separation
- Lead dislodgment
- Lead infection
Evaluation
- CXR to evaluate the placement of the leads
Management
- Cardiologist for device/lead placement
Disposition
- Admit to allow for device intervention as pacemaker does not function in Twiddler's Syndrome
