The Twiddler Syndrome

A 55-year-old woman received a diagnosis of the sick sinus syndrome. A dual-chamber pacemaker was implanted with one lead in the right atrium and the other lead in the right ventricle (Panel A). The leads were inserted without complication through the left cephalic vein and secured with sutures. One week after implantation, the pacemaker functioned well. Two weeks later, the patient visited the emergency room with a report of stimulation of the diaphragm. A radiograph of the chest demonstrated displacement of both leads, with winding of the leads around the pacemaker box (Panel B, arrow). The patient reported having twisted . . .