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Introduction Intraoperative right ventricular perforation due to pacing catheter after its successful and uneventful insertion is a rare complication. Here, we present a case of cardiac arrest due to right ventricular perforation associated with a pacemaker lead during off-pump coronary artery bypass graft surgery. Case Presentation The case was a 68-year-old male, who was admitted to our hospital with retrosternal chest pain. He had a history of implantation of a permanent pacemaker due to symptomatic complete atrioventricular block. Based on angiography, the diagnosis was 3- vessel disease involving the left anterior descending, second obtuse marginal, and right coronary arteries. The right ventricle was perforated by the tip of the permanent pacemaker lead during off-pump coronary artery bypass graft surgery. Subsequently, the patient suddenly experienced cardiac arrest and underwent emergency on-pump cardiac surgery. Conclusions This case showed that in some situations, emergency surgery as a life saving procedure may be required in cardiac perforation due to permanent pacemaker lead even following cardiac arrest.