A pacemaker lead wedged into the chest

An 88-year-old man with atrial fibrillation and slow ventricular rate was referred for pacemaker implantation. A single-chamber pacemaker was successfully placed with the active fixation lead supposedly implanted into the anterior free wall of the right ventricle. At the 48-h follow-up, the pacemaker resulted unable to capture the myocardium. The stimulus induced by magnet application was not able to get a myocardial capture. A chest computed tomography revealed the perforation of the myocardial wall by the ventricular lead which crossed the pericardium and the pleural leaflets, ‘wedging’ into the intercostal space (thick, black arrows). The physical exam during perforation was unremarkable. Mild pericardial effusion was observed (thin, black arrows). On heart surgery stand-by, the catheter was successfully extracted transvenously and replaced in the interventricular septum without further complications.