Renaming Twiddler's syndrome: an argument for change to reflect a diverse set of aetiologies, patients and devices

Twiddler's syndrome is a rare complication where the leads attached to cardiac pacemakers or deep brain stimulator (DBS) implantable pulse generators (IPG) become twisted from device rotation. The medical lore has traditionally suggested that patients manipulate the device, with 'twiddling' being more common in elderly and obese individuals due to increased loose subcutaneous tissue, which facilitates device rotation.This report describes a case of a woman in her late 60s with DBS for Parkinson's disease who sustained trauma that presumably caused dislodgement of IPG anchoring stitches, leading to rotation of the IPG without manipulation by the patient. It aims to augment the existing literature on this syndrome and suggests that device rotation can occur without deliberate movement by the patient, challenging the conventional understanding of the syndrome's aetiology. We propose a new name for the syndrome, PETS: Pulse generator Electrode Twisting Syndrome, which is more inclusive of its causes.