Double twiddle trouble, a new variant of twiddler syndrome

The twiddler syndrome results in retraction and coiling of the lead in the pacemaker pocket with subsequent pacemaker malfunction. If the lead׳s parameters are not affected, then the problem can be corrected by lead repositioning. We describe the first reported case of a dramatic pacemaker lead coiling with a double level of lead compromise, with one of them being intra-cardiac. This condition affected our treatment strategy, as the repositioning of the lead was unfeasible.