A 73-year-old lady underwent dual-chamber pacemaker implantation at another institution due to sinus node disease. Seven days after the procedure, she presented with intermittent left chest muscle twitching. At admission there was ineffective ventricular pacing. Chest X-ray showed right ventricular (RV) perforation (Figure 1A). Preprogramming the pacemaker to atrial (AAI) mode resolved the muscle stimulation. A three-dimensional computer tomogram reconstruction revealed the ventricular lead (Medtronic lead model 5076—58 cm) perforating the RV free wall, pericardium, left pleura, and intercostal muscle (Figure 1B and Q. The patient deteriorated overnight developing cardiac tampo-nade. The lead was removed using emergency median sternotomy without extra-corporeal circulation (Figure 1D).
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