LAUSR

Introduction Pacemaker and implantable cardioverter-defibrillator (ICD) lead perforations are well described and may cause many complications. Delayed cardiac perforation (DCP) is a less recognized complication of device implantation and is believed to be rare. We present a case of DCP wherein 2 simultaneous ICD lead perforations occurred in the right ventricle (RV) and were overlooked on chest radiograph (CXR) and chest computed tomography (CT) images. In patients with implanted cardiac leads presenting with chest pain or dyspnea, physicians familiar with typical lead placement should review the radiology images, and not simply read the reports, to recognize lead perforations.