Pacemaker Twiddler Syndrome - A Rare but Serious Cause of Pacemaker Malfunction

Twiddler's syndrome is a rare complication after pacemaker implantation. It is caused by conscious or unconscious manipulation at the implantation site by the patient with the result of device malfunction. It results in lead dislodgment, diaphragmatic stimulation, and loss of capture. In a pacemaker dependent patient, it can be a lethal complication. It usually occurs in the first year following pacemaker implantation. The treatment involves readmission, repositioning of the dislodged leads and suture fixation of the lead and pulse generator within its pocket. We report a case of 84-year-old female who was readmitted after 4 weeks of implantation of permanent pacemaker with syncope and diaphragmatic stimulation.