A DDDR pacemaker was implanted in an 85-year-old woman due to symptomatic Mobitz II AV block. A month later, she went to the Emergency Department due to pleuritic chest pain in the right hemithorax in a stable hemodynamic and respiratory situation with oxygen saturation by pulse oximetry of 98% without oxygen supply. Posteroanterior chest X-ray (Fig. 1), chest computed tomography (CT), and 3D VR (Volume rendering) chest CT (Fig. 2, Fig. 3) were performed. Right pneumothorax (black arrows) and introduction of the tip of the atrial electrocatheter into the pleural space (white arrows) due to late perforation of the right atrium were observed. An echocardiogram was performed, which ruled out a pericardial effusion. Surgical removal of the atrial lead was decided by the Cardiac Surgery Department, without complications.

Fig. 1.

Chest radiograph. anteroposterior view

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Fig. 2.

3D VR chest tomography. Tip into pleural space

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Fig. 3.

Chest computed tomography.

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