This causes coiling of the lead and its dislodgement, resulting in failure of ventricular pacing. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. The pacemaker-twiddler’s syndrome is an uncommon cause of pacemaker malfunction. This case indicates that extreme physical forces in the absence of direct trauma, such as during amusement park rides, may result in lead fractures and patients with pacemakers should be cautioned regarding such activities.
In our case, the fracture occurred during amusement park rides and went undiagnosed until the patient presented for routine pacemaker evaluation. We present an interesting case of complete severance of the tip of a dual-chamber pacemaker’s atrial lead after a high-velocity theme park ride. Treatment involves placement of a new lead with or without extraction of the fractured lead. Diagnosis is made by ECG and careful review of chest imaging such as chest X-ray or fluoroscopy. These patients usually present with symptoms of dizziness, syncope, chest discomfort, and palpitations or less commonly with extracardiac symptoms. Pacemaker lead fracture is one of the most common causes of pacemaker malfunction and is most frequently associated with weight lifting or chest trauma.
