Twiddler syndrome is a rare condition which occurs when a patient, either consciously or unconsciously, rotates or “twiddles” the implanted pacemaker in its pocket, resulting in torsion, dislodgement, and often fracture of the pacing lead. The diagnosis is confirmed by a chest radiograph which reveals a twisted, entangled, and dislodged pacing lead. The syndrome usually occurs when the subcutaneous tissues are lax, if the pacemaker is untethered in its pocket, or if the size of the pacemaker pocket exceeds that of the device, and is seen especially in children and obese and older patients.1 In the case of a pediatric patient the dislodgement of a pacemaker lead is more problematic because the child's growth must be taken into account. There is frequently loss of capture and pacemaker malfunction. In many cases it is necessary to explore the pacemaker pocket surgically and replace the lead.
