Twiddler's syndrome
Twiddler’s syndrome
Twiddler’s syndrome happens when a pacemaker or heart defibrillator is moved or twisted in the skin pocket where it sits. People may “twiddle” the device, causing the wires (leads) to coil or dislodge from their proper position. When this happens, the device stops helping the heart beat properly and symptoms can appear.
What can happen
- Leads can wrap around the device, so the heart isn’t paced or shocked as intended.
- If the phrenic nerve is affected, you may get hiccups or involuntary breathing movements.
- If the brachial plexus is affected, you may notice regular arm twitching.
- In people with an implanted defibrillator, shocks may become painful or ineffective.
- In severe cases, devices like CRT or ICD may fail, which can be dangerous.
Who’s at risk
- Women, people who are obese, older adults
- Those with cognitive problems
- People with a smaller device than the pocket it sits in
- More loose tissue under the skin or newer, smaller devices can move more easily
Diagnosis
- A chest X-ray is the simplest and most important test. It shows the lead twisting and the device rotating.
Treatment
- Doctors can reposition the pulse generator in the pocket.
- Leads may need to be replaced or repositioned, and the coil unwrapped.
If Twiddler’s syndrome is found, timely treatment can restore proper device function and heart pacing or shocks.
This page was last edited on 2 February 2026, at 12:58 (CET).