Twiddler’s Syndrome- An Uncommon Cause of Pacemaker Malfunction in Elderly

Abstract

Twiddler's syndrome is a relatively unusual cause of pacemaker failure. When a patient manipulates the pacemaker pulse generator within its skin pocket, either purposefully or unintentionally, this happens. This causes the lead to coil and detach, resulting in ventricular pacing failure. It can also induce unusual symptoms like phrenic nerve stimulation, which causes belly pulsing, or brachial plexus stimulation, which causes rhythmic arm twitching. The phenomena is more common in elderly ladies with reduced cognition, and it usually happens within the first year of pacemaker placement. The dislodged leads are repositioned, and the lead and pulse generator are sutured back into place within their pocket. In older individuals who show with bradyarrhythmias after pacemaker installation, Twiddler's syndrome should be evaluated as a cause of pacemaker failure. For its diagnosis, chest X-rays and electrocardiograms are easy and readily available first-line examinations. Lead repositioning is required, but long-term care requires good patient education and counseling against further manipulation.