The pacemaker-twiddler's syndrome: Another disadvantage of abdominal implantation of pulse generators

Abstract

Breakage of a pacer lead due to the pacemaker-twiddler's syndrome (PTS) occurred in 4 of 62 survivors following epicardial-intramural pacer lead implantation with the pulse generator placed in each case in a subcostal left upper quadrant subcutaneous pocket. The abdominal pulse generator pocket appears to invite spontaneously occurring PTS, more so in a pregnant woman. The important predisposing factor to the development of PTS is an excessively spacious pulse generator pocket containing a pool of fluid. Addition of a few simple modifications to the technique of cardiac pacing would prevent the complication; these include implantation of the pulse generator in a plane deeper to the pectoral muscles, suspending the pulse generator from the clavicle and application of vacuum-suction drainage to the generator pocket in the initial phase of wound healing. In the presence of an optimally fitting pulse generator pocket, PTS should be rare with subclavicular subpectoral pulse generator implantation without active patient participation. The syndrome may not be as rare a cause of pacer lead malfunction as may appear from the relative paucity of reports in the literature.

An Implantation of DDD Epicardial Pacemaker Through Ministernotomy in a Patient with a Superior Vena Cava Occlusion

“…When epicardial leads are used, the generator is usually placed in a subcostal subcutaneous pocket. But the abdominal implantation of a pulse generator has some disadvantage compared to pectoral implantation, for example, pacemaker‐twiddler's syndrome 7 . Because the distance from the subxiphoid process to the subcutaneous pocket on the left pectoral region is rather long, the connection of the epicardial leads to the generator in the pectoral subcutaneous pocket is difficult.…”