29:
141:, and having an implanted device that is smaller than its pocket. A related increase in subcutaneous tissue laxity, especially in older patients, makes it easier for the device to become dislodged. Furthermore, the newer devices' smaller sizes make it easy for them to rotate inside the skin pocket.
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Twiddler's syndrome presents with a range of symptoms, contingent on the extent of entanglement, the electrode's subsequent retraction, and the final location of the dislodged lead. Leads that become more dislodged up can activate the ipsilateral
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due to manipulation of the device and the consequent dislodging of the leads from their intended location. As the leads move, they stop pacing the heart and can cause strange symptoms such as
450:
Sharifi, Mohsen; Inbar, Shmuel; Neckels, Brenda; Shook, Heather (March 2005). "Twiddling to the extreme: development of twiddler syndrome in an implanted cardioverter-defibrilllator".
113:
Patient "twiddling," or manipulation, of the pulse generator within its skin pocket results in the device's painless dislodgment; lead dislodgement follows, eventually leading to
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Dursun, Ihsan; Yesildag, Osman; Soylu, Korhan; Yilmaz, Ozcan; Yasar, Erdogan; Meric, Murat (August 16, 2006). "Late pacemaker twiddler syndrome".
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Repositioning the pulse generator, implanting a new lead, and uncoiling the lead are among the treatments for diagnosed cases.
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malfunction. There have also been reports of variations of this phenomenon resulting in the failure of implanted cardioverter-
526:
Castillo, Ricardo; Cavusoglu, Erdal (2006). "Twiddler's
Syndrome: An Interesting Cause of Pacemaker Failure".
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Salahuddin, Mohammad; Cader, Fathima Aaysha; Nasrin, Sahela; Chowdhury, Mashhud Zia (January 20, 2016).
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Asbach, Stefan; Brunner, Michael; Zehender, Manfred; Bode, Christoph; Faber, Thomas S. (December 2005).
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Nicholson, William J.; Tuohy, Kathryn A.; Tilkemeier, Peter (April 24, 2003). "Twiddler's
Syndrome".
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is stimulated by additional coiling and withdrawal of the lead, which causes regular arm twitches.
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stimulation resulting in rhythmic arm twitching. Twiddler's syndrome in patients with an implanted
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Given its speed and ability to provide a clear image of the lead coiling and device rotation, the
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185:"The pacemaker-twiddler's syndrome: a new complication of implantable transvenous pacemakers"
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is the most straightforward and important diagnostic tool for
Twiddler's syndrome.
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288:"The pacemaker-twiddler's syndrome: an infrequent cause of pacemaker failure"
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Furman, Seymour (1995). "Defibrillator
Twiddler's syndrome".
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The condition's risk factors include being a woman, being
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Fahraeus, T (2003). "Early pacemaker twiddler syndrome".
344:"A rare case of very early pacemaker Twiddler′s syndrome"
626:(10). Springer Science and Business Media LLC: 547–549.
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may lead to inadequate, painful defibrillation-shocks.
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are wrapped around the device and can't be seen in the
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Pande, Arindam; Kahali, Dhiman; Mandal, Saroj (2012).
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Bayliss C, Beanlands D.S., et al. (August 1968).
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412:(17). Massachusetts Medical Society: 1726–1727.
298:(1). Springer Science and Business Media LLC.
76:stimulation resulting in abdominal pulsing or
39:showing twiddler's syndrome. The leads of the
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189:Canadian Medical Association Journal
452:The Journal of Invasive Cardiology
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123:cardiac resynchronization therapy
41:automated external defibrillator
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620:Clinical Research in Cardiology
406:New England Journal of Medicine
583:The Annals of Thoracic Surgery
230:Wiener klinische Wochenschrift
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595:10.1016/s0003-4975(95)81037-4
494:10.1016/s1099-5129(03)00032-1
534:(2). S. Karger AG: 119–121.
589:(2). Elsevier BV: 544–545.
418:10.1056/nejm200304243481722
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632:10.1007/s00392-006-0417-4
305:10.1186/s13104-015-1818-0
243:10.1007/s00508-005-0480-2
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361:10.4103/1995-705x.102157
125:, which can be fatal.
97:, which can result in
68:is a malfunction of a
139:cognitive impairments
354:(3). Medknow: 114.
66:Twiddler's syndrome
22:Twiddler's syndrome
746:External resources
292:BMC Research Notes
88:Signs and symptoms
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165:References
58:Cardiology
796:Syndromes
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731:SNOMED CT
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548:0008-6312
502:1099-5129
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370:1995-705X
314:1756-0500
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157:Treatment
145:Diagnosis
115:pacemaker
70:pacemaker
53:Specialty
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510:12842644
482:Europace
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765:Scholia
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