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Twiddler's Syndrome.
Vincent Sneyers1, Bjorn Valgaeren2, Brecht Van Berkel2
1UZ Leuven, Herestraat 49, 3000 Leuven, Belgium.
Twiddler's syndrome is a rare complication after neurostimulator or pacemaker implantation. It occurs when the generator twists, causing electrode dislodgement or interruption, which is detectable on X-ray.
Area of Science:
- Medical Devices
- Neurosurgery
- Radiology
Background:
- Twiddler's syndrome is a rare but severe complication following the implantation of neurostimulators or pacemakers.
- It arises from the mechanical manipulation of the implanted generator within its subcutaneous pocket.
Purpose of the Study:
- To highlight the etiology and radiographic findings of Twiddler's syndrome.
- To emphasize the importance of recognizing this complication for appropriate patient management.
Main Methods:
- Review of clinical cases and radiographic findings associated with Twiddler's syndrome.
- Analysis of the mechanism of generator migration and electrode disruption.
Main Results:
- Twiddler's syndrome involves the twisting of the generator, leading to lead dislodgement or malfunction.
- Radiographic examination is crucial for diagnosing the dislodged electrodes and abnormal generator position.
Conclusions:
- Twiddler's syndrome is a preventable complication that requires awareness among implanting physicians.
- Early diagnosis via X-ray is essential for timely intervention and to prevent further complications.

