CTICasesSpontaneous Pacemaker Lead Retraction and Coiling
Imaging findings
Serial radiographs demonstrate spontaneous migration and coiling of a right atrial pacemaker lead. While initially well-positioned, subsequent radiographs over a two-month period show the lead has retracted out of the atrium and has wound itself into multiple coils within the pulse generator pocket, while the right ventricular lead remains fixed.
Key takeaways
Spontaneous retraction and coiling of a pacemaker lead within its pocket is a classic manifestation of Twiddler's syndrome or its variants, often driven by patient manipulation of the pulse generator or repetitive arm movements. In some cases, anatomical changes such as gravity-induced displacement of breast tissue in females standing upright can pull on leads, emphasizing the need to secure both the pulse generator and leads properly at the time of surgical implantation.
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