Twiddle me this? Twiddled (Twiddler) Syndrome: A Case Report

Background: Twiddler syndrome is a rare but known complication after pacemaker (PM) placement. Causes of Twiddler syndrome have been described in case reports throughout the last fifty years, which has further elucidated our understanding of risk factors and mechanisms of PM dysfunction Summary: We describe a case of Twiddler syndrome caused by migrating PM due to a lack of security to the pectoral fascial layer. Conclusion: Due to the increasing number of iatrogenic causes of PM dysfunction, we propose differentiation from Pacemaker Twiddler Syndrome with known manipulation and Pacemaker Twiddled Syndrome, which includes iatrogenic causes of PM dysfunction. Additionally, the case highlights the importance of a diagnosis in the emergency department, cardiology consultation, and prompt pacemaker replacement.