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A 69 year-old obese female with poorly controlled ventricular rates in atrial fibrillation
(AF) underwent single chamber pacemaker implantation followed by an atrioventricular
node ablation one month later. The chest X-ray performed after the ablation showed
the header of pulse generator facing medially (arrow) with satisfactory right ventricular,
mid-septal lead positioning (Fig. 1A ). During a coronary angiogram for angina six months later, the right anterior fluoroscopic
view of the pacing lead showed a double twist within the right atrium (arrow) (Fig. 1B). In addition, the pulse generator had flipped horizontally (arrow) (Fig. 1C). The patient denied ‘twiddling’ with the device. Fortunately, pacemaker lead function
remained normal.
Figure 1(A) Chest X-ray one month post implantation showing the header of pulse generator
facing medially (arrow) with satisfactory right ventricular, mid-septal lead positioning.
(B) Right anterior oblique fluoroscopic view of the pacing lead showing a double twist
within the right atrium (arrow). (C) Fluoroscopic view of the pacemaker generator
showing that it has been flipped horizontally (arrow). (D) Classic Twiddler's syndrome
with leads coiling around pulse generator.
