Clinical & Experimental Cardiology
Open Access

Abstract

Extreme Twiddling: Unusual Presentation of an Old Foe

Ahmed FZ, Allen S and Zaidi A

Characteristic twiddling and lead macro-displacement are well-documented radiological hallmarks of Twiddler’s Syndrome. What is less well known is that the different variants of Twiddler’s Syndrome can be distinguished by assessing orientation of the pins on X-ray. Illustrations of a change in orientation of the header and pins are rarely reported in cases of pacemaker Twiddler’s Syndrome and the phenomenon has not been described in implantable cardioverter-defibrillator recipients. We highlight an important classic finding that is seldom depicted in the literature