1. José L. Morales et al. JACEP 2017;j.jacep.2017.02.015
Variants and Mechanism Described in Twiddler’s Syndrome (A) Classic twiddler’s syndrome: extreme twisting of the lead outside of the pocket. Presumed mechanism: conscious or unconscious manipulation of the pulse generator (PG) causing it to rotate around its long axis. (B) Reel syndrome: the lead gets reeled around the PG. Presumed mechanism: rotation of the PG rotating around its transverse axis. (C) Ratchet syndrome: the lead appears coiled around the PG similar to reel syndrome, but involves only 1 lead. Presumed mechanism: with each movement of the arm, the lead lightly, but constantly, moves toward the PG. (D) Reverse reel syndrome and (E) reverse twiddler’s syndrome: in both, the leads are pushed forward from the pocket toward the heart.
José L. Morales et al. JACEP 2017;j.jacep
2017 American College of Cardiology Foundation