eng Science and Education Publishing American Journal of Cardiovascular Disease Research 2025-12-30 10 1 15 17 10.12691/ajcdr-10-1-3 AJCDR20251013 article Resha Reya Ganthan reshareya15@gmail.com 1 Rayna Isber 2 Joud Fahed 3 Nidal Isber 4 Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA Barnard College, New York City, NY, USA Department of Internal Medicine, Ascension St Agnes Hospital, Baltimore, USA Department of Electrophysiology, Richmond University Medical Center, Staten Island, NY, USA Twiddler syndrome is a rare complication of cardiac implantable electronic devices (CIEDs) typically caused by patient manipulation of the generator, leading to lead dislodgement. We present a unique case of a patient with a biventricular implantable cardioverter-defibrillator (ICD) who developed atrial and ventricular lead dislodgement without evidence of device manipulation. The patient experienced six consecutive inappropriate ICD shocks due to oversensing and double counting of atrial and ventricular signals by the right ventricular (RV) lead. This case highlights a variant of Twiddler syndrome occurring in the absence of twiddling, underscoring the importance of vigilance for device malfunction even without patient-induced factors. https://pubs.sciepub.com/ajcdr/10/1/3/ajcdr-10-1-3.pdf Twiddler syndrome Implantable cardioverter-defibrillator (ICD) Lead dislodgement Device malfunction Inappropriate shocks Cardiac implantable electronic device (CIED) Lead migration