Twiddler's syndrome, a rare but potentially lethal complication of cardiac pacemaker treatment, is generally diagnosed within the first year of implantation. It is characterized by device malfunction due to dislodgement of cardiac leads resulting from some form of manipulation by the patient. In this report we present a patient who was diagnosed Twiddler's syndrome within the initial 48 h of implantation of permanent pacemaker. In our case, passive fixation of ventricular lead perpetuated this situation and subsequent active fixation prevented any recurrence. Active fixations fixations of device leads are very much essential to prevent this catastrophic complication.
Keywords: Pacemaker; Pacing leads; Twiddler’ syndrome.