Q: What is twiddler syndrome?

Answer:

Twiddler's syndrome is a known complication of pacemakers. It occurs when a patient manipulates and rotates the pulse generator that it results in lead dislodgment, diaphragmatic stimulation and loss of capture. Its  incidence is higher than as thought, around 0.07-7%. Possible causes include elderly age group, obesity, female gender, psychiatric illness, and the small size of the implanted device relative to its pocket. Most dramatic effect beside failure to pace is diaphragmatic contraction by phrenic nerve stimulation, vagus nerve, pectoral muscle, or brachial plexus stimulation resulting in rhythmic arm twitching.

Although originally described with pacemakers, the condition is also reported with implantable cardioverter-defibrillators.

References:

Fahraeus T, Hijer CJ. Early pacemaker Twiddler syndrome. Europace. 2003;5:279–81.

Gupta R, Lin E. Twiddler syndrome. J Emerg Med. 2004;26:119–20.

Castilo R, Cavusoglu E. Twiddler's syndrome: An interesting cause of pacemaker failure. Cardiology. 2006;105:119–21.

Nicholson WJ, Tuohy KA, Tilkemeier P. Twiddler's syndrome. N Engl J Med. 2003;348:1726–7.

Sharif M, Inbar S, Neckels B, Shook H. Twiddling to the extreme: Development of Twiddler syndrome in an implanted cardioverter-defibrillator. J Invasive Cardiol. 2005;17:195–6.