Aggressive pacemaker twiddler's syndrome. Dislodgement of an active fixation ventricular pacing electrode.

Pacemaker twiddler's syndrome is the phenomenon whereby a pacemaker patient may actively dislodge a pacing electrode by manipulating, often unconsciously, the permanent implanted pacemaker. This unusual case is remarkable in several respects: surgical precautions, originally taken to secure the pulse generator against migration, proved ineffective; the displaced lead featured an active fixation "screw-in" electrode; and the reported dislodgement occurred not in the early postimplant stage, but fully three months later. It can be concluded that even with advanced lead technology and operative precaution, electrode dislodgement cannot be absolutely prevented. Awareness of this phenomenon, especially by pacemaker follow-up care personnel, could lessen its occurrence.