A pacemaker or cardioverter defibrillator may be manipulated by the patient who "twiddles" with the battery pack. Repeated twisting of the pacemaker can cause a lead to become displaced or to fracture, causing a failure in electrical stimulation.


Classification of Dittrich et al:

(1) partial - some effective cardiac stimulation occurs

(2) complete - no effective cardiac stimulation


Risk factors:

(1) obese patient (loose subcutaneous tissue)

(2) elderly patient (loose subcutaneous tissue)

(3) failure to adequately secure the device during initial placement

(4) learning disability or mental retardation (failure to comprehend the need not to play with the device)

(5) psychiatric disorder

(6) high physical activity

(7) frequent fiddling or playing with the device


Preventive measures:

(1) education of the patient about the importance of not mishandling the device

(2) securely fastening the pacemaker to fascia in a small surgical pouch


The device and the lead placement can be monitored with a chest X-ray.


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