Late fatal right ventricular perforation as complication of permanent pacing leads

Perforation of the right ventricle during placement of pacing electrodes is a well-documented complication. Most of these perforations occur intraoperatively and rarely cause symptoms. This case report describes a fatal cardiac perforation that occurred 10 days after implantation of a permanent cardiac pacemaker. This complication should be considered as one of the potential mechanisms responsible for the high rate of sudden death observed in paced patients during the first year after pacemaker implantation.