Abstract
A 69 year-old obese female with poorly controlled ventricular rates in atrial fibrillation (AF) underwent single chamber pacemaker implantation followed by an atrioventricular node ablation one month later. The chest X-ray performed after the ablation showed the header of pulse generator facing medially (arrow) with satisfactory right ventricular, mid-septal lead positioning (Fig. 1A). During a coronary angiogram for angina six months later, the right anterior fluoroscopic view of the pacing lead showed a double twist within the right atrium (arrow) (Fig. 1B). In addition, the pulse generator had flipped horizontally (arrow) (Fig. 1C). The patient denied ‘twiddling’ with the device. Fortunately, pacemaker lead function remained normal. Traditional Twiddler’s syndrome occurs when circular rotation of the device retracts the leads out of the heart with leads
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