Twiddler syndrome - retracted pacemaker leads

Case contributed by Assoc Prof Craig Hacking

Presentation

Atypical palpitations.

Patient Data

Age: 75 years
Gender: Female

The two permanent pacemaker leads are retracted superiorly. One is projected in the right atrium, the other in the left subclavian vein. Redundant lead coils are noted around the left-sided generator superiorly. 

The heart is enlarged.

Case Discussion

The patient was known to have obsessive-compulsive disorder and admitted to fiddling with the chest wall generator.

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