Causes of pacemaker lead dislodgement

Twiddler' syndrome, reel syndrome, and ratchet syndrome are rare yet dangerous phenomena of pacemaker lead dislodgement. Twiddler's syndrome was first reported by Bayliss . In this case report, we describe an interesting case of pacemaker lead dislodgement by unconscious manipulation of the device pocket by a patient who presented eight months ...

1 Eki 2016 ... ... pacing spikes are absent. Causes of output failure are generally lead failure (lead fracture, lead displacement), generator failure, battery ...Underlying causes — A variety of conditions can lead to the development of cardiac arrhythmias. Some of the more common causes include: ... Lead dislodgement is more common in the first few weeks after implantation. The hospital stay is usually brief, and the procedure can be performed as an outpatient. ... The pacemaker leads are usually ...Citation, DOI, disclosures and article data. Lead dislodgement, also known as twiddler syndrome, is a complication of implanted cardiac conduction devices due to patient manipulation of the pulse generator, typically diagnosed on plain chest radiograph. A variation of this complication can also occur with implantable ports, deep brain ...Here, we report a case of atrial lead dislodgement 15 years after an implantable cardioverter-defibrillator (ICD) implantation. 2 CASE REPORT. 1), and ICD interrogation revealed a loss of capture of the atrium despite maximal output from the atrial lead and a decreased sensing threshold (P wave, 0.2–0.8 mV). Chest X-rays revealed …Once correct lead positioning is confirmed, the lead is affixed to the endocardium either passively with tines (like a grappling hook) or actively via a helical screw located at the tip. The screw at the tip of the pacemaker is extended or retracted by turning the outer end of the lead with the help of a torque device.Reel's syndrome is a rare cause of pacemaker failure, resulting from the dislodging of pacing electrodes by manipulation of the pulse generator by the patient. We describe here an intriguing case of pacemaker lead dislodgement by a novel and frequently underdiagnosed mechanism that mimicked the fluoroscopic diagnosis of reel's syndrome.Pacemaker lead Ratchet-traction Reel syndrome abstract Pacing lead dislodgement contributes substantially, to the list of causes of early pacemaker failure. Reel's syndrome is a rare cause of pacemaker failure, resulting from the dislodging of pacing electrodes by manipulation of the pulse generator by the patient. We describe here

Citation, DOI, disclosures and article data. Lead dislodgement, also known as twiddler syndrome, is a complication of implanted cardiac conduction devices due to patient manipulation of the pulse generator, typically diagnosed on plain chest radiograph. A variation of this complication can also occur with implantable ports, deep brain ...Introduction. Pacemaker lead macrodislodgement is an unusual occurrence and is typically thought to be caused by Twiddler's syndrome, 1 Reel syndrome, 2 or trauma to the pacemaker system, 3 all of which are mechanisms for lead dislodgement evolving from manipulation of the generator and/or lead. In this report, we postulate the cause of a transvenous active fixation right ventricular lead ...Reel's syndrome is a rare cause of pacemaker failure, resulting from the dislodging of pacing electrodes by manipulation of the pulse generator by the patient. We describe here an intriguing case of pacemaker lead dislodgement by a novel and frequently underdiagnosed mechanism that mimicked the fluoroscopic diagnosis of reel's syndrome.We report two cases of late SelectSecure 3830 lead dislodgement at 11.8 years (Case 1) and 8.8 years (Case 2), respectively, post the initial implantation. Case 1 …Introduction. With the advances in pacemaker generator and lead designs over the past three decades, there has been a gradual shift towards placement of transvenous pacing systems in young children with encouraging short and medium to long-term outcomes. 1, 2 However, the life-long pacing requirement in linearly growing …In large straight vein branches or in redo procedures after lead dislodgement, with anticipated poor lead stability, a special active fixation lead (e.g., Medtronic Attain Stability Quad) is recommended. This lead is equipped with a sharp hook that is attached to the lead body at some distance proximal to the lead tip.

The pacemaker-twiddler’s syndrome refers to the permanent malfunction of a pacemaker resulting from manipulation of the pulse generator within its skin pocket [1]. This leads to a rotation of the device, coiling of the lead and its dislodgement, leading to pacemaker failure.What causes pacemaker lead dislodgement? First described in 1968, refers to permanent malfunction of a pacemaker due to the patient’s manipulation of the pulse generator. The patient, inadvertently or deliberately, turns and rotates the generator on its long axis and, because of traction, causes the lead displacement.Dislodgement of a right ventricular (RV) defibrillation lead may cause inappropriate shocks that initiate fatal proarrhythmia. Lead dislodgement (LD) at the right atrium may result in simultaneous sensing of both atrial and ventricular electrograms (EGMs), causing inappropriate detection of ventricular tachycardia (VT) or ventricular …Lead dislodgement/fracture (requires repositioning or replacement of lead). ... Since the pacing lead is in the right ventricle causing this chamber to get ...Lead dislodgement syndromes (Twiddler, Ratchet or Reel syndromes) are rare causes of cardiac stimulation device malfunction that can occur most commonly early after device …The unique nature of this case increases the importance of considering device lead dislodgement as the cause for patients presenting with extra-cardiac symptoms. Pacemaker lead stimulation of surrounding structures can present in an unusual fashion, masking the diagnosis. Lead dislodgement should always be considered as a differential diagnosis ...

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Twiddler's syndrome, Lead dislodgement, Pacemaker malfunction Introduction. Twiddler's syndrome was first described by Bayliss, et al. in 1968, when a patient manipulated and rotated the pulse generator in the pocket resulting in lead dislodgement, diaphragmatic stimulation, and loss of capture . It occurs because of unintentional or deliberate ...Early displacements are more frequent than late displacements and they usually affect atrial leads. The incidence of early displacements is 1% in VVI pacemakers and 5.2% in DDD …To the Editor, Poor lead positioning of implantable electronic cardiac devices is rare and discovered incidentally on occasion, but can have serious complications. 1 Dislodgement of correctly positioned leads is common, however, and can be a significant source of clinical complications for patients with these devices. Lead dislodgement may be an incidental, …Unfortunately, all these techniques seem doomed to failure. Recurrences have been reported with all of these. However, using leadless pacemaker implantation will also likely reduce lead dislodgement and hence, prevent Twiddler syndrome from occurring . In conclusion, pacemaker lead dislodgement is an unusual occurrence.Lead dislodgement is a known complication after cardiac rhythm device placement (pacemakers, defibrillators, and cardiac resynchronization devices), …

The incidence of LCP device dislodgement was 0%, 0.13%, and 1% in three leadless pacemaker studies. Conclusions. The incidence rates of conventional pacemaker lead dislodgement vary in individual studies with an overall high incidence. Use of the currently available LCP systems appears to result in a lower rate of device dislodgement.The pacemaker-twiddler’s syndrome refers to the permanent malfunction of a pacemaker resulting from manipulation of the pulse generator within its skin pocket [1]. This leads to a rotation of the device, coiling of the lead and its dislodgement, leading to pacemaker failure.16 Kas 2021 ... The frequency of long-term lead displacement ranges between 1.8% and 8.0%. In our case, the patient did not present any symptoms and the lead ...There is a clear association between low atrial septal lead position and lead dislodgement requiring lead revision. ... 3451 patients (mean age 73.9, 53.4 % male) underwent dual-chamber pacemaker placement. Active fixation leads were associated with a higher incidence of pericardial effusion (81 (2.9 %) vs. 6 (1.0 %), p = 0.005) and ...Mechanical factors may cause pacemaker erosion. The incidence of permanent pacemaker perforation is between 0.5% and 2% . A mandatory echocardiographic follow-up evaluation is needed to remain vigilant for this fatal complication. Acute perforation of the right ventricle or right atrium occurs in 1% of the patients [5,6].The symptoms of pacemaker syndrome included dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, hypotension, pre-syncope, and even syncope . Heart failure signs include elevated neck veins, rales, and pedal edema. Physical exam can often reveal cannon A-waves.Background. Pacemaker lead dislodgement causes malfunctions in the pacing system. Late dislodgement is deined as dis- lodgement occurring more than 6 weeks after …Moreover 1-2% of these patients will encounter severe lead-related problems within 30 days of their pacemaker insertion. In this report, we focus on an uncommon but serious complication of PPM insertion: right ventricular lead perforation leading to a pericardial effusion. Although lead perforation is a relatively rare occurrence, this event ...common cause was lead dislodgement (66%), then malfunctioning (20%) or perforation (18%) [5]. Right atrial lead dislodgement was the most common at this study registry followed by ICD lead [5]. At this large registry, they proposed the possible causes of dislodgment are inadequate fixation of the lead sleeve in one third of the study cases

Twiddler's syndrome, Lead dislodgement, Pacemaker malfunction Introduction. Twiddler's syndrome was first described by Bayliss, et al. in 1968, when a patient manipulated and rotated the pulse generator in the pocket resulting in lead dislodgement, diaphragmatic stimulation, and loss of capture . It occurs because of unintentional or deliberate ...

We tried to identify the causes of lead dislodgments. In almost 1/3 of the cases the sleeves on the leads were not fixed adequately and in 2/3 of the cases the cause of dislodgement was unclear. ... Right atrial and ICD leads caused more dislodgement compared with RV pacemaker leads. Lead perforation was more common with RV leads, especially ...Introduction. Pacemaker lead macrodislodgement is an unusual occurrence and is typically thought to be caused by Twiddler's syndrome, 1 Reel syndrome, 2 or trauma to the pacemaker system, 3 all of which are mechanisms for lead dislodgement evolving from manipulation of the generator and/or lead. In this report, we postulate the cause of a transvenous active fixation right ventricular lead ...A pacemaker can prevent death that might occur due to severe arrhythmia. When the heartbeat is irregular, too slow or too fast, the heart may fail to pump enough blood to vital body organs. A pacemaker regulates the heartbeat and prevents s...Medtronic CapSureFix MRI 5086 pacing lead (5086; Medtronic, Inc., Minneapolis, MN, USA) has been reported to be associated with increased cardiac perforation and lead dislodgement. This study aimed to compare the incidence of cardiac perforation and lead dislodgement within 30 days after pacemaker i …There are several causes that result in the failure capture of a pacemaker, including battery depletion, lead dislodgement, circuit problems, acidosis, and hyperkalemia . Although pacemaker malfunction induced by ischemia is rare, there are still some previous case reports that demonstrated an atrial lead malfunction after a myocardial infarction.The venous thrombosis associated with permanent pacemaker leads was first described a few years after the first endocardiac pacemakers were implanted. ... were not the cause of the fatal outcome of our patient. There are several useful imaging techniques for the diagnosis of pacing lead thrombosis in the right heart chambers. Transthoracic ...A, Frontal chest radiograph shows Medtronic single-chamber pacemaker on right and CPI (Cardiac Pacemakers Incorporated) implantable cardioverter defibrillator (ICD) on left. Each device has different type of bipolar right ventricle (RV) lead. Tip electrodes are located at termination of both RV leads, whereas short proximal metallic opacity on ...CT scan of the patient does not usually cause problems in the pacemakers. Therefore, the presence of an implanted pacemaker should not hinder such investigative imaging modality. In rare cases, it might …Early diagnosis of defibrillation lead dislodgement. JACC Clin Electrophysiol. 2018; 4:1075–1088. doi: 10.1016/j.jacep.2018.03.015 Crossref Medline Google Scholar; 22. Kreis DJ, LiCalzi L, Shaw RK. Air entrapment as a cause of transient cardiac pacemaker malfunction. Pacing Clin Electrophysiol.

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Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach: and 02PAXMZ: Removal of Cardiac Lead from Heart, External Approach : 02HL3JZ: Insertion of Pacemaker Lead into Left Ventricle, Percutaneous Approach: and 02PA0MZ: Removal of Cardiac Lead from Heart, Open Approach : 02HL3JZ: Insertion of Pacemaker Lead into …Reel's syndrome is a rare cause of pacemaker failure, resulting from the dislodging of pacing electrodes by manipulation of the pulse generator by the patient. We describe here an intriguing case of pacemaker lead dislodgement by a novel and frequently underdiagnosed mechanism that mimicked the fluoroscopic diagnosis of reel's syndrome.in coiling of the lead and lead dislodgement, thereby causing pacemaker malfunction. Retraction of the electrode may cause phrenic nerve stimulation resulting in diaphragmatic stimulation and a sensation of abdominal pulsations. As the leads are further wrapped around the generator, rhythmic arm twitching mayInsertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach: and 02PAXMZ: Removal of Cardiac Lead from Heart, External Approach : 02HL3JZ: Insertion of Pacemaker Lead into Left Ventricle, Percutaneous Approach: and 02PA0MZ: Removal of Cardiac Lead from Heart, Open Approach : 02HL3JZ: Insertion of Pacemaker Lead into …Twiddler's syndrome is a rare cause of pacemaker lead dislodgement. We present the case of a 49-year-old male patient with Down's syndrome implanted with a dual chamber pacemaker showing high ventricular impedance, no sensing, and complete loss of capture for both leads at the 3-month follow-up due to Twiddler Syndrome. The dislocated device ...Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach: and 02PAXMZ: Removal of Cardiac Lead from Heart, External Approach : 02HL3JZ: Insertion of Pacemaker Lead into Left Ventricle, Percutaneous Approach: and 02PA0MZ: Removal of Cardiac Lead from Heart, Open Approach : 02HL3JZ: Insertion of Pacemaker Lead into …between both systems. Epicardial leads are implanted using median sternotomy, and sutured to the epicardial surface of the heart. Pacemaker generator is located in the abdominal cavity and the lead tunnelized through the anterior aspect of the diaphragm. Globally speaking, complications rate is estimated among 5% to 13%.The pacemaker rotates on its long axis, resulting in dislodgement of pacing leads. Can result in diaphragmatic or brachial plexus pacing (e.g. arm twitching) depending on extent of lead migration. ECG in Pacemaker Malfunction. Normal pacemaker rhythms can result in absent pacing activity, irregular pacing and absence of pacing spikes.L ead displacement is a common complication of pacemaker device implantation, often resulting in prolonged hospital stays and increased costs. The frequency of long-term lead displacement ranges between 1.8% and 8.0%. In our case, the patient did not present any symptoms and the lead displacement was seen at a relatively late stage.The use of TPEAF leads is safe and efficacious in pacemaker-dependent patients post-TLE. Dislodgement can occur within the first 24 h. The presence of ...Jan 14, 2021 · Pacemaker lead dislodgement causes malfunctions in the pacing system. Late dislodgement is defined as dislodgement occurring more than 6 weeks after pacing system implantation . Classification of lead dislodgement includes macro-dislodgement and micro-dislodgement. ….

Other potential complications related to the lead may include lead dislodgement, lead conductor fracture or insulation failure or threshold elevation or exit ...The use of TPEAF leads is safe and efficacious in pacemaker-dependent patients post-TLE. Dislodgement can occur within the first 24 h. The presence of ...Cardiac pacemaker malposition; Malposition of cardiac pacemaker; ICD-10-CM T82.128A is grouped within Diagnostic Related Group(s) (MS-DRG v 41.0): 314 Other circulatory system diagnoses with mcc; 315 Other circulatory system diagnoses with cc; 316 Other circulatory system diagnoses without cc/mcc; Convert T82.128A to ICD-9-CM. Code HistoryDislodgment is one of the most common causes of device failure (“non-capture”) in the early time period after implantation. 2 In the pacemaker selection in the elderly trial, the dislodgment complication was estimated to be 2.2%. 3 Several factors contribute to a lead's susceptibility to dislodge, and multiple solutions have been ...Twiddler' syndrome, reel syndrome, and ratchet syndrome are rare yet dangerous phenomena of pacemaker lead dislodgement. Twiddler's syndrome was first reported by Bayliss . In this case report, we describe an interesting case of pacemaker lead dislodgement by unconscious manipulation of the device pocket by a patient who presented eight months ...Drinking plenty of fluids, especially water, dislodges a pill that is stuck in the throat, advises WebMD. If the medication can be taken with food, eating a piece of bread also helps resolve the problem.Indications for extraction of chronically implanted pacemaker leads have been classified as mandatory, necessary, or discretionary.1 ,2In published reports as well as in clinical practice, most indications cited are non-vital. These indications are often based on clinical judgement, even in published policy statements.3 We therefore reviewed published work on this subject, starting from the ...Most cases of malfunction are associated with the electronics in the pulse generator or dislodgement or fracture of the leads. External causes are less common and include electrolyte disorders, metabolic disorders, hypoxemia, antiarrhythmic drugs, or electromagnetic disturbance caused by other machines/devices.Twiddler' syndrome, reel syndrome, and ratchet syndrome are rare yet dangerous phenomena of pacemaker lead dislodgement. Twiddler's syndrome was first reported by Bayliss . In this case report, we describe an interesting case of pacemaker lead dislodgement by unconscious manipulation of the device pocket by a patient who presented eight months ...Pacemaker leads are, accordingly, a blood flow-perturbing element, which can in turn cause thrombosis due to blood recirculation or stasis. Additionally, it is suspected that thrombosis is also triggered by endothelial injuries caused by contact of the leads with the endothelium lining the vessels and with the endocardium [101]. Epstein and ... Causes of pacemaker lead dislodgement, 13 May 2014 ... SafePace is a mechanical device that could lower the rate of lead dislodgement of pacemakers ... SafePace does not cause any additional harm to ..., L ead displacement is a common complication of pacemaker device implantation, often resulting in prolonged hospital stays and increased costs. The frequency of long-term lead displacement ranges between 1.8% and 8.0%. In our case, the patient did not present any symptoms and the lead displacement was seen at a relatively late stage., Pacemakers consist of a pulse generator or can, which contains the battery and electronics, and leads, which travel from the can to contact the myocardium, to deliver a depolarizing pulse and to sense intrinsic cardiac activity (Figure 2).Insulation materials separate the conductor cables and the lead tip electrodes. Depending on the relationship …, Pacemaker lead macrodislodgement is an unusual occurrence and is typically thought to be caused by Twiddler’s syndrome, 1 Reel syndrome, 2 or trauma to the …, L ead displacement is a common complication of pacemaker device implantation, often resulting in prolonged hospital stays and increased costs. The frequency of long-term lead displacement ranges between 1.8% and 8.0%. In our case, the patient did not present any symptoms and the lead displacement was seen at a relatively late stage., Lead dislodgement; Cardiac perforation; Poor connection between lead and pacemaker; Lead maturation: as the lead matures and becomes surrounded by fibrotic tissue, the threshold of stimulation decreases, which may result in non-capture; Twiddler’s syndrome: a permanent malfunction of a pacemaker due to the patient's manipulation of …, The most frequent complication of pacemaker leads has been reported to be dislodgement, and the FOLLOWPACE study showed that dislocation of an atrial lead within 2 months was found in 1.9% of patients with active lead fixation and 3.9% of patients with passive lead fixation (P = .059). For a mean of 5.8 years except the first 2 months, its ..., Complications with pacemaker implantations are uncommon but can include infection, swelling at the surgical site (seroma), and potentially lead dislodgement. Lead dislodgement is one of the most concerning complications, but this can largely be avoided with strict activity restriction for 4-6 weeks following the pacemaker implantation procedure., identified causes of undersensing.3,4 As with failure to capture, the onset of undersensing relative to the time of device implantation helps identify the cause. Undersens-ing occurring shortly after implantation may be due to lead dislodgement or malposition or to cardiac perfora-tion. If it occurs later, it could be due to battery deple-, Abstract. Objectives: This study sought to develop and evaluate an algorithm for early diagnosis of dislodged implantable cardioverter-defibrillator (ICD) leads. Background: Dislodged defibrillation leads may sense atrial and ventricular electrograms (EGMs), triggering shocks in the vulnerable period that induce ventricular fibrillation (VF)., The pacemaker rotates on its long axis, resulting in dislodgement of pacing leads. Can result in diaphragmatic or brachial plexus pacing (e.g. arm twitching) depending on extent of lead migration. ECG in Pacemaker Malfunction. Normal pacemaker rhythms can result in absent pacing activity, irregular pacing and absence of pacing spikes., CT scan of the patient does not usually cause problems in the pacemakers. Therefore, the presence of an implanted pacemaker should not hinder such investigative imaging modality. In rare cases, it might …, These can cause symptoms such as dyspnea, palpitations, and decompensated heart failure. Early detection of these arrhythmias and optimal pacemaker programming is pivotal. The aim of this review article is to summarize the different types of pacemaker‐mediated arrhythmias, their predisposing factors, and mechanisms of …, The Twiddler's syndrome is a rare cause of pacemaker or ICD malfunction, and characterized by the dislodgement of the lead(s), due to rotation or other manipulation of the pulse generator. In some ..., Early displacements are more frequent than late displacements and they usually affect atrial leads. The incidence of early displacements is 1% in VVI pacemakers and 5.2% in DDD pacemakers (3.8% of the cases affecting atrial leads and 1.4% ventricular leads). Acceptable displacement rates should probably be less than 1 percent for ventricular ..., Lead dislodgement is a known complication after cardiac rhythm device placement (pacemakers, defibrillators, and cardiac resynchronization devices), …, Lead dislodgement or malfunction and time of occurrence A total of 3909 leads were implanted. During the first year of follow-up a total of 74 (1.9 %) lead dislodgements or malfunctions occurred in 71 (3.7 %) patients: 57 (1.4 %) dislodgements and 17 (0.5 %) malfunctions. Regarding lead dislodgement, the right atrial (RA) lead (1.9 %) showed the, Inadvertent pacemaker lead dislodgement. Transcatheter aortic valve implantation (TAVI) has become an established treatment option for aortic valve stenosis in patients with a high risk for conventional surgical valve replacement. A well-known complication is the development of conduction abnormalities. In the case of a new third-degree ..., Cardiac pacemakers (CPM) and implantable cardioverter defibrillators (ICD) are indispensable treatment option for the cardiac arrhythmias. The most common complication of pacemaker implantation is lead dislodgement. We will present eight patients with lead dislodgement about Twiddler, Reel and Ratchet Syndromes., 24 Ağu 2011 ... Several months later, winding of pacemaker lead around generator can be seen on PA chest radiograph (B), causing dislodgement of ventricular ..., Lessons learned since the first transvenous pacemakers were implanted >50 years ago have led to important advances in pacing technology. Active-fixation leads make many alternative pacing sites possible, may prevent lead dislodgement, and may provide advantages in cases where lead extraction becomes necessary. 1 However, active …, Recovery from the procedure is rapid, but there may be some restrictions on arm movement and activities for the first two to four weeks. Lead dislodgement is more common in the first few weeks after implantation. The hospital stay is usually brief, and the procedure can be performed as an outpatient., Pacemakers consist of a pulse generator or can, which contains the battery and electronics, and leads, which travel from the can to contact the myocardium, to deliver a depolarizing pulse and to sense intrinsic cardiac activity (Figure 2).Insulation materials separate the conductor cables and the lead tip electrodes. Depending on the relationship …, The use of TPEAF leads is safe and efficacious in pacemaker-dependent patients post-TLE. Dislodgement can occur within the first 24 h. The presence of ..., The symptoms of pacemaker syndrome included dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, hypotension, pre-syncope, and even syncope . Heart failure signs include elevated neck veins, rales, and pedal edema. Physical exam can often reveal cannon A-waves., A, Frontal chest radiograph shows Medtronic single-chamber pacemaker on right and CPI (Cardiac Pacemakers Incorporated) implantable cardioverter defibrillator (ICD) on left. Each device has different type of bipolar right ventricle (RV) lead. Tip electrodes are located at termination of both RV leads, whereas short proximal metallic opacity on ..., In a review article, the most common complications reported with passive fixation leads were failure of venous access (15%), failure to place a lead (10%), and sepsis (9%). 11 Hyman et al. studied 1,022 patients at the Mayo Clinic who required conventional temporary pacing. 9 Lead dislodgement occurred in 17.9% of patients and was the …, Citation, DOI, disclosures and article data. Lead dislodgement, also known as twiddler syndrome, is a complication of implanted cardiac conduction devices due to patient manipulation of the pulse generator, typically diagnosed on plain chest radiograph. A variation of this complication can also occur with implantable ports, deep brain ..., We report a case of inadvertent dislodgement of a permanent pacemaker lead after removal of a preoperatively placed venous sheath in a TAVI patient. Keywords: TAVI; …, A Micro-dislodgement is a minimal displacement in the lead that is not visible in a chest X-ray, but has the ability to increase the capture threshold and eventually cause a loss of capture. Lead dislodgement can cause sensing failure, which occurs when proper atrial or ventricular sensing is not achieved by the programming of the pacemaker., To minimize the risk of perforation, the surgeon should abstain from excessive advancement of the helix during lead fixation, excessive pressure on the lead, excessive loop, and forced dislodgement of the lead with an extended screw for instance due to dislocation of the atrial lead during the insertion of a ventricular lead, which should ..., The pacemaker-twiddler’s syndrome refers to the permanent malfunction of a pacemaker resulting from manipulation of the pulse generator within its skin pocket [1]. This leads to a rotation of the device, coiling of the lead and its dislodgement, leading to pacemaker failure., The cause for lead failure may be identified on fluoroscopy. As older transvenous ICD leads are substantially thicker than conventional pacing leads, they are exposed to higher forces below the clavicle when using a subclavian vein access. Lead fracture typically affects one of the inner conductors of a coaxial or triaxial lead.