title: A tangled affair: pacemaker malfunction and syncope in a child due to Twiddler's syndrome.
abstract: Manipulation of an implanted pacemaker by the patient is a rare cause of malfunction, especially in children. We describe a child who inadvertently rotated his pacemaker under the skin, knotting the leads and dislodging them from the heart, leading to syncope and heart block. Our experience with this case underscores the need to consider this diagnosis in children as well as in adults if this problem is to be averted.
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital, Medical University of South Carolina, Charleston, South Carolina 29425, USA. ellisa@musc.edu
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Ellis
authors.forename: John H
authors.initials: JH
authors.lastname: Reed
authors.forename: David
authors.initials: D
authors.lastname: Fairbrother
mesh_terms: D002648:Child; D020878:Device Removal; D004562:Electrocardiography; D004868:Equipment Failure; D018729:Fontan Procedure / Q000009:adverse effects*; D006327:Heart Block / Q000209:etiology / Q000628:therapy*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D013575:Syncope / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D013577:Syndrome