A Case of Subcutaneous Implantable Cardioverter-Defibrillator Twiddler's Syndrome

Twiddler’s syndrome is a rare complication where a pacemaker or implantable cardioverter-defibrillator (ICD) is displaced with or without patient manipulation of their device. There are reports on transvenous devices but a paucity of data on subcutaneous devices. A 50-year-old male with hypertrophic cardiomyopathy and non-sustained ventricular tachycardia underwent subcutaneous-ICD (S-ICD) implantation for primary prevention. Remote device interrogation 4 weeks after device placement reported a shock due to “ventricular fibrillation”. It also showed abnormal lead impedance. Chest X-ray showed lead was dislodged and coiled around the pulse generator. Patient underwent lead revision and device replacement without further complications.