Introduction
Twiddler’s syndrome refers to deliberate or unintentional twisting of the pulse generator in a device pocket resulting in lead displacement. This will usually present as a malfunction of the pacemaker or ICD.1 Patients may be asymptomatic or can present with a variety of symptoms including inappropriate shocks, failure to capture, diaphragmatic contraction, pectoral muscle stimulation, or brachial plexus stimulation.2 In the past 50 years, twiddler’s syndrome with transvenous ICDs (TV-ICD) and pacemakers has been well-described and thoroughly studied. However, there are limited data on twiddler’s syndrome with the S-ICDs. We report a case of S-ICD twiddler’s syndrome and a review of the current perspective of twiddler’s syndrome.