CTICasesTwiddler Syndrome with Pacemaker Lead Retraction and Phrenic Nerve Stimulation
▶ Watch on YouTube — age-restricted, cannot embed here
Imaging findings
An old radiograph from AICD placement showed no pneumothorax. A follow-up radiograph, obtained when the patient presented with diaphragmatic pacing, showed that the AICD lead had retracted and was twisted around itself and the generator within the chest wall. The lead was clearly not perforating the right ventricle.
Key takeaways
This is a classic presentation of Twiddler syndrome, where the pacemaker generator is manipulated (consciously or subconsciously), causing the lead to retract and twist. This can lead to phrenic nerve stimulation and diaphragmatic pacing (as seen here), or brachial plexus activation if it retracts further. It is more common in elderly or obese patients with looser connective tissue, often requiring a sub-pectoral pouch for replacement.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Dermatomyositis with Organizing Pneumonia and Non-Specific Interstitial PneumoniaAutoimmune
- Spontaneous Left Anterior Descending Artery (LAD) DissectionVascular
- Transcatheter Aortic Valve Implantation (TAVI) Complication: Acute Right Coronary Artery (RCA) Occlusion and Valve MigrationIatrogenic
- Sarcoidosis Presenting with HypocalcemiaAutoimmune
- Progressive Interstitial Lung Fibrosis with Dendriform OssificationsILD
- Asymmetric Interstitial Lung Fibrosis in Systemic SclerosisILD
- Pulmonary Calcified Axis (Metastatic Calcification)Metabolic
- PKP2-Related Glycogen Storage Disease with Cardiac Hypertrophy and Pre-excitationMetabolic
See all cases from March 27, 2015 →
Related Iatrogenic cases
- Pulmonary Vein Stenosis Post-Ablation with Collaterals
- Ethiodol-Induced Fat Embolism Syndrome
- Iatrogenic Superior Vena Cava Rupture
- Constrictive Pericarditis, Fibrothorax, and Iatrogenic Left Atrial Cannulation by Chest Tube
- Carotid-Jugular Fistula and Mediastinal Hematoma
- Iatrogenic Aortic Intramural Hematoma