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The pacemaker-twiddler’s syndrome: an infrequent cause of pacemaker failure

BACKGROUND: The pacemaker-twiddler’s syndrome is an uncommon cause of pacemaker malfunction. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. This causes coiling of the lead and its dislodgement, resulting in failure of...

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Autores principales: Salahuddin, Mohammad, Cader, Fathima Aaysha, Nasrin, Sahela, Chowdhury, Mashhud Zia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4721019/
https://www.ncbi.nlm.nih.gov/pubmed/26790626
http://dx.doi.org/10.1186/s13104-015-1818-0
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author Salahuddin, Mohammad
Cader, Fathima Aaysha
Nasrin, Sahela
Chowdhury, Mashhud Zia
author_facet Salahuddin, Mohammad
Cader, Fathima Aaysha
Nasrin, Sahela
Chowdhury, Mashhud Zia
author_sort Salahuddin, Mohammad
collection PubMed
description BACKGROUND: The pacemaker-twiddler’s syndrome is an uncommon cause of pacemaker malfunction. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. This causes coiling of the lead and its dislodgement, resulting in failure of ventricular pacing. More commonly reported among elderly females with impaired cognition, the phenomenon usually occurs in the first year following pacemaker implantation. Treatment involves repositioning of the dislodged leads and suture fixation of the lead and pulse generator within its pocket. CASE PRESENTATION: An 87 year old Bangladeshi lady who underwent a single chamber ventricular pacemaker (VVI mode: i.e. ventricle paced, ventricle sensed, inhibitory mode) implantation with the indication of complete heart block, and presented to us again 7 weeks later, with syncopal attacks. She admitted to repeatedly manipulating the pacemaker generator in her left pectoral region. Physical examination revealed a heart rate of 42 beats/minute, blood pressure 140/80 mmHg and bilateral crackles on lung auscultation. She had no cognitive deficit. An immediate electrocardiogram showed complete heart block with pacemaker spikes and failure to capture. Chest X-ray showed coiled and retracted right ventricular lead and rotated pulse generator. An emergent temporary pace maker was set at a rate of 60 beats per minute. Subsequently, she underwent successful lead repositioning with strong counselling to avoid further twiddling. CONCLUSION: Twiddler’s syndrome should be considered as a cause of pacemaker failure in elderly patients presenting with bradyarrythmias following pacemaker implantation. Chest X-ray and electrocardiograms are simple and easily-available first line investigations for its diagnosis. Lead repositioning is required, however proper patient education and counselling against further manipulation is paramount to long-term management.
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spelling pubmed-47210192016-01-22 The pacemaker-twiddler’s syndrome: an infrequent cause of pacemaker failure Salahuddin, Mohammad Cader, Fathima Aaysha Nasrin, Sahela Chowdhury, Mashhud Zia BMC Res Notes Case Report BACKGROUND: The pacemaker-twiddler’s syndrome is an uncommon cause of pacemaker malfunction. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. This causes coiling of the lead and its dislodgement, resulting in failure of ventricular pacing. More commonly reported among elderly females with impaired cognition, the phenomenon usually occurs in the first year following pacemaker implantation. Treatment involves repositioning of the dislodged leads and suture fixation of the lead and pulse generator within its pocket. CASE PRESENTATION: An 87 year old Bangladeshi lady who underwent a single chamber ventricular pacemaker (VVI mode: i.e. ventricle paced, ventricle sensed, inhibitory mode) implantation with the indication of complete heart block, and presented to us again 7 weeks later, with syncopal attacks. She admitted to repeatedly manipulating the pacemaker generator in her left pectoral region. Physical examination revealed a heart rate of 42 beats/minute, blood pressure 140/80 mmHg and bilateral crackles on lung auscultation. She had no cognitive deficit. An immediate electrocardiogram showed complete heart block with pacemaker spikes and failure to capture. Chest X-ray showed coiled and retracted right ventricular lead and rotated pulse generator. An emergent temporary pace maker was set at a rate of 60 beats per minute. Subsequently, she underwent successful lead repositioning with strong counselling to avoid further twiddling. CONCLUSION: Twiddler’s syndrome should be considered as a cause of pacemaker failure in elderly patients presenting with bradyarrythmias following pacemaker implantation. Chest X-ray and electrocardiograms are simple and easily-available first line investigations for its diagnosis. Lead repositioning is required, however proper patient education and counselling against further manipulation is paramount to long-term management. BioMed Central 2016-01-20 /pmc/articles/PMC4721019/ /pubmed/26790626 http://dx.doi.org/10.1186/s13104-015-1818-0 Text en © Salahuddin et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Salahuddin, Mohammad
Cader, Fathima Aaysha
Nasrin, Sahela
Chowdhury, Mashhud Zia
The pacemaker-twiddler’s syndrome: an infrequent cause of pacemaker failure
title The pacemaker-twiddler’s syndrome: an infrequent cause of pacemaker failure
title_full The pacemaker-twiddler’s syndrome: an infrequent cause of pacemaker failure
title_fullStr The pacemaker-twiddler’s syndrome: an infrequent cause of pacemaker failure
title_full_unstemmed The pacemaker-twiddler’s syndrome: an infrequent cause of pacemaker failure
title_short The pacemaker-twiddler’s syndrome: an infrequent cause of pacemaker failure
title_sort pacemaker-twiddler’s syndrome: an infrequent cause of pacemaker failure
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4721019/
https://www.ncbi.nlm.nih.gov/pubmed/26790626
http://dx.doi.org/10.1186/s13104-015-1818-0
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