A 65 year old man was admitted because of faintness and syncope. His ECG showed complete atrioventricular block with a heart rate of 30 beats/min. A transvenous temporary pacing electrode was inserted immediately via the right femoral vein. No complications were observed during the procedure. Coronary angiography was performed on the second day because of chest pain, and showed normal coronary arteries. The patient experienced severe chest pain and haemodynamic collapse two hours after coronary angiography. Transthoracic echocardiography demonstrated pericardial tamponade and the pacing electrode wire crossed the free right ventricular wall (panel). Surgical closure of the right ventricular free wall perforation and pericardial drainage was performed. A permanent pacemaker was later inserted without further complication.

Heart perforation caused by a transvenous pacemaker is a rare complication.