Twiddler's syndrome


  • 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, often by patient 'twiddling' a recently-implanted pacemaker.

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


Wrapped pacemaker lead showing Twiddler's syndrome.
Wrapped pacemaker lead showing Twiddler's syndrome.
  • CXR to evaluate the placement of the leads


  • Cardiologist for device/lead placement


  • Admit to allow for device intervention as pacemaker does not function in Twiddler's Syndrome

See Also

External Links