Cardiac implantable electronic device malfunction due to twiddler's syndrome in a patient with bipolar affective disorder

A 49-year-old man presented to our emergency department with dyspnoea and fluid overload. He denied any chest pain. Comorbidities included non-dilated ischaemic cardiomyopathy and bipolar affective disorder. An admission ECG demonstrated sinus rhythm with left bundle branch block (QRS duration=126