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Previous Volume 348:1726-1727 April 24, 2003 Number 17 Next

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To the Editor: First described in 1968, pacemaker twiddler's syndrome refers to permanent malfunction of a pacemaker due to the patient's manipulation of the pulse generator.¹ The sequence of symptoms begins with the patient's deliberate or subconscious spinning of the pacemaker's pulse generator in a capacious pocket. The leads are dislodged, and ventricular pacing ceases. Subsequently, with continual reeling of the leads around the generator, the ipsilateral phrenic nerve is stimulated, resulting in diaphragmatic pacing and the sensation of abdominal pulsations. As the leads are further wrapped around the generator, rhythmic arm twitching occurs when the brachial plexus is paced.

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