A case of what was assumed to be twiddler's syndrome was caused by spontaneous twisting and displacement of the electrode on the fortieth postoperative day. The pacemaker had not been manipulated by the patient, the pocket was tight, and the proximal electrode was well secured. The complication was managed successfully by reimplanting the same electrode after stiffening the lead near the generator with a portion of the stylet.
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Gialafos et al. (1989) studied this question.
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