Twiddler's syndrome detected by patient's complaint of implantable cardioverter-defibrillator rotation in the subcutaneous pocket

Abstract Twiddler's syndrome presents as a rare implantable-cardioverter defibrillator (ICD) malfunction that is potentially fatal. The following case is that of a 79-year-old woman, who was implanted with an ICD and experienced Twiddler's syndrome. Five months after the implantation, the patient complained that the generator sometimes rotated in the subcutaneous pocket. Fluoroscopy showed that the generator had rotated and the leads were twisted, which is compatible with Twiddler's syndrome. Although all the leads were functioning normally, a procedure to repair the twisted leads was performed. Twiddler's syndrome is usually detected due to a serious device malfunction; however, this case study suggests that it can be detected prior to ICD malfunction by the patient's complaint.