Twiddler syndrome mimicking an abdominal aortic aneurysm

In conclusion, phrenic nerve stimulation due to LV lead dislodgement can mimic an abdominal aortic aneurysm. Pacemaker rotation leading to lead displacement was previously described by Bayliss et al. as Twiddler’s syndrome [1] and has a reported frequency of 0.07–7 % [2]. It was named after patients who twiddled with the device resulting in rotation and lead dislodgement. However, the syndrome can also occur spontaneously. It causes failure to pace and can result in stimulation of the brachial plexus, vagus nerve, pectoral muscle, or the phrenic nerve [2]. Twiddler’s syndrome is more frequent in older female and obese patients probably due to more subcutaneous space between the cutis and pectoral muscle [3, 4]. Fixating the device at the pectoral fascia can prevent this complication.