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Beware of the twiddler

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Diseases change with the times, it seems

Diseases change with the times, it seems. One that is beginning to trouble doctors is twiddler's syndrome, a condition that is affecting an increasing number of people fitted with pacemakers.

It's a situation brought on by the patient himself - he just won't stop twiddling with the pulse generator, which is attached to the internal pacemaker and sits in a surgical pocket. The constant twiddling eventually dislodges the leads, and they start coiling around the generator as the twiddling continues. As a result, the diaphragm starts pacing and the abdomen begins pulsating. In its final stages, the patient's arms start twitching involuntarily - almost in a Hitler-like salute.

Sometimes, admit doctors, the patient is not at fault - or, at least, not directly. They have found that the extra layers of fat in obese patients can accidentally knock the pulse generator, resulting in the same distressing effects as those caused by the Twiddler (N Engl J Med, 2003; 348: 1726-7).


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