Twiddler's syndrome: an unusual cause of pacemaker malfunction

Sinus nodal dysfunction is common in the elderly and frequently requires a permanent cardiac pacemaker. Current pacemakers are extremely reliable but require ongoing monitoring to detect battery depletion and component or lead failure. This report describes a patient's manipulation of the pacemaker generator and proximal leads within the subcutaneous pocket with lead fracture and device malfunction. Diagnosis by chest X-ray and surgical revision are portrayed. Awareness of Twiddler's syndrome remains the key to its diagnosis.