Twiddler's syndrome: a new twist.

Twiddler's syndrome, characterized by dislodgment of pacemaker leads due to twisting of pulse generators within the subcutaneous pocket with subsequent retraction of leads and loss of pacing function, has been well described in patients with permanent pacemakers implanted for bradyarrhythmias. The case presented here is the first report of a patient with an internal automatic cardioverter-defibrillator with lead dislodgment due to pulse generator rotation. This case exemplifies a new subset of patients prone to the Twiddler's syndrome.