Twiddler Syndrome: A Case Report

Background: Pacemaker (PM) devices are increasingly used to treat cardiac conduction abnomality especially in elderly population. Twiddler syndrome (TS) in PM patients is a condition where patient manipulation of a pacemaker leads to its retraction and dysfunction. TS can be extremely dangerous in patient who depend on PM rhythm and therefore can be fatal.

Case Summary: We present the case of a 52-year-old women who underwent implantation of a of pacemaker for idiopathic third degree auriculo-ventricular block. Forty days after the operation she was admitted to the hospital for recurrent episodes of syncope. Chest radiographs confirmed lead retraction and suggested device manipulation. The patient was immediately transferred to the cath lab to perform a repositioning of the Pacemaker leads.

Discussion: This rare case highlights the life threatening aspect of Twiddler syndrome related to pacemaker. Hence rigorous fixationof the generator and leads is essential, close follow up and meticulous examination of EKG, X ray is primordial especially in the first year following the intervention. Finally patient should be educated not to manipulate their devices with clear explanation of potential consequence of such behavior.