Defibrillator twiddler's syndrome

Long-term complications of internal cardioverter defibrillators have generally involved inappropriate shocks or hardware malfunctions. The present case documents a new problem of internal cardioverter defibrillator lead disruption resulting from patient-induced rotation of the generator In its pocket, similar to the previously reported pacemaker twiddler's syndrome. However, unlike the usual early symptoms of pacemaker nonfunction, the first symptomatic manifestation of the defibrillator twiddler's syndrome may be an inappropriate internal cardioverter defibrillator discharge or mote importantly, unrescued sudden death. Careful attention to patient complaints about the internal cardioverfer defibrillator generator and being alert to subtle lead changes on chest radiographs may allow the clinician to recognize this syndrome before a major, possibly fatal event.