Pacemaker twiddler's syndrome: report of a case.

A patient with symptomatic atrioventricular blockage who had been treated by permanent pacemaker implantation, developed twiddler's syndrome 16 days after implantation. The electrode lead to the pacemaker pocket had been completely displaced, with the electrode tip having moved to the outside of the subclavian vein. Complete atrioventricular block was demonstrated by electrocardiogram. Reimplantation of the same electrode at the apex of the right ventricle relieved the symptoms. The patient is regularly followed up at an outpatient clinic and continues to be well. Although twiddler's syndrome is a rare complication of pacemaker implantation, preventive measures should be undertaken especially for those judged to be at high risk.