Twiddler syndrome, Reel syndrome, and ratchet syndrome are rare but potentially life-threatening complications after implantable pacemaker and defibrillator surgeries. These conditions can occur when the electrodes become dislocated, leading to reduced stimulation and sensitivity. This negates the benefits of implantable devices, such as improved qualityof life and reduced mortality from sudden cardiac death. Our clinical case demonstrates typical causes, risk factors, symptoms, diagnosis, and prevention strategy of this dislocation syndrom. The most common cause is believed to be conscious or unconscious patient manipulation of the device. Risk factors include female gender, obesity, surgical errors, and mental illness. The features of the clinical picture are discussed, which can make diagnosis and treatment difficult. Options for treatment and prevention are presented. Problems and limitations are highlighted.

Anton Nalivaiko has completed his PHD at the age of 32 years from FSBEI ROSUNIMED» of MOH of Russia, RF. He is interventional cardiologist of EP lab department of Clinical hospital named after I.V. Davydovskogo, RF. He has 4 publications.