PMID: 589003Sep 1, 1977

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

The British Journal of Surgery
B N GuharayA K Basu


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.


Apr 1, 1974·JAMA : the Journal of the American Medical Association·G E KimA M Imparato
Jun 10, 1974·JAMA : the Journal of the American Medical Association·F G Azzam
Aug 19, 1974·JAMA : the Journal of the American Medical Association·S FURMAN
Nov 1, 1974·The British Journal of Surgery·B N GuharayA K Basu
Nov 1, 1968·The Annals of Thoracic Surgery·J W HarthorneW G Austen
Nov 1, 1968·The Annals of Thoracic Surgery·R G Terzi, P Hutchin
Dec 7, 1963·JAMA : the Journal of the American Medical Association·D H KLOTZJ H STUCKEY
Jun 1, 1965·American Journal of Surgery·S FURMANB RUBINSTEIN


Dec 1, 1994·Pacing and Clinical Electrophysiology : PACE·V ParsonnetA Omar
May 1, 1995·Pacing and Clinical Electrophysiology : PACE·J GialafosP Toutouzas
Mar 15, 1986·British Medical Journal·M J Waterson, M N Fahie-Wilson
Mar 1, 1980·Pacing and Clinical Electrophysiology : PACE·R RosenthalR P Coomaraswamy
Mar 1, 1981·Pacing and Clinical Electrophysiology : PACE·W B LokN Goldschlager
Nov 1, 1984·Pacing and Clinical Electrophysiology : PACE·E P VeltriP R Reid
Apr 18, 2003·Pacing and Clinical Electrophysiology : PACE·Hidenori SakoHirotsugu Hamamoto

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