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Twiddler syndrome

Imaging findings

Chest radiograph shows a cardiac pacemaker generator flipped and rotated in its subcutaneous pocket, resulting in the retraction and coiling of the right ventricular lead back into the right atrium.

Key takeaways

Twiddler syndrome involves the rotation of a pacemaker or ICD generator in its pocket, causing the leads to coil around the device and retract from the heart. This can occur in capacious pockets during normal activities of daily living.

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