Twiddler Syndrome: A Rare Complication with Important Clinical Relevance

Abstract

Twiddler syndrome is a rare complication observed after implantation of pacemakers and ICDs due to conscious or unconscious “twiddling” at the implantation side with the result of device malfunction. In patients at risk for all solutions proposed in literature to date (active fixation, small pockets, subpectoral implantation, etc.) have been reported cases of failure. We describe a new technique based on additional suture of the leads. In our experience it revealed to be very useful and we think that it could be applied with success in patient at risk for life.