Removing the Twiddling stigma: spontaneous lead retraction without patient manipulation.

After pacemaker or implantable cardioverter-defibrillator (ICD) implantation, it takes weeks for the leads to scar in place. Occasionally, newly implanted leads dislodge by retracting towards the device pocket. This phenomenon is generally called 'Twiddler's Syndrome,' with the invoked mechanism being patient manipulation of the device pocket. We present a case of a 27-year-old man who had complete retraction of the atrial lead, but not the ventricular lead, after a submuscular dual-chamber ICD implantation. The specifics of this case demonstrate that leads can spontaneously retract during normal arm movement, without any conscious or unconscious device manipulation by the patient. Leads must be firmly secured in the device pocket via their suture sleeves in order to minimize the risk of retraction, regardless of mechanism.