Pectoral muscular twitching: a rare manifestation of spontaneous twiddler syndrome

The twiddler syndrome is an uncommon cause of pacemaker malfunction, in which twisting or rotating of the device in its pocket results in lead retraction or coiling and subsequent malfunction of an implanted devices such as a pacemaker, an implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT).  This report describes a rare case of twiddler syndrome after implantation of a ICD that manifested with pectoral muscular twitching. A seventy-three years old woman who underwent primary prevention single-chamber ICD implantation (Figure 1) due to ischemic cardiomyopathy, presented to us with feeling of stinging and twitching around the generator in left