Twiddler's syndrome is a malfunction of a pacemaker due to manipulation of the device and the consequent dislodging of the leads from their intended location.

[2] Twiddler's syndrome presents with a range of symptoms, contingent on the extent of entanglement, the electrode's subsequent retraction, and the final location of the dislodged lead.

[3] Leads that become more dislodged up can activate the ipsilateral phrenic nerves, which can result in hiccups, involuntary breathing spasms, or diaphragmatic contractions.

[6] The condition's risk factors include being a woman, being obese, belonging to an older age group, having cognitive impairments, and having an implanted device that is smaller than its pocket.

[3] Given its speed and ability to provide a clear image of the lead coiling and device rotation, the chest X-ray is the most straightforward and important diagnostic tool for Twiddler's syndrome.