Perforation of right ventricular free wall by pacemaker lead detected by multidetector computed tomography

Pacemaker lead perforation is a recognized complication of lead implantation, particularly with active fixation leads. Multidetector computed tomography (MDCT) is emerging as the imaging modality of choice in diagnosing lead perforation, identifying associated sequelae such as pericardial effusion and planning extraction. We present a case illustrating the use of MDCT in a case of right ventricular (RV) lead perforation manifesting 5 days after cardiac resynchronization therapy pacing.