Pacemaker-twiddler's syndrome: a rare cause of lead displacement and pacemaker malfunction

Pacemaker-twiddler's syndrome is characterized by spontaneous, subconscious, inadvertent, or deliberate rotation of the pulse generator by the patient resulting in lead dislodgement and pacemaker malfunction. We present a case of pacemaker-twiddler's syndrome that involved an atrioventricular sequential pacemaker. It resulted in failure of atrial lead capture and phrenic nerve stimulation but without loss of ventricular lead capture. A search of the literature revealed only ten previous cases reported; none were in the emergency medicine literature, and none involved an atrioventricular sequential pacemaker.