An 81-year-old hypertensive woman underwent dual chamber permanent pacemaker implantation for sinus node disease at another hospital. Both atrial and ventricular leads were active fixation leads (Tendril ST Optim 1888TC, St Jude Medical, St. Paul, MN, USA) and were inserted via the left cephalic vein. The atrial lead was screwed into the right atrial free wall. Chest X-ray after implantation showed adequate lead position and no pneumothorax. After initial unremarkable postoperative monitoring, the patient complained of sudden onset of chest pain and shortness of breath on the second day. Auscultation revealed diminished breath sounds on the right. Chest X-ray and computed tomography scan demonstrated right-sided pneumothorax and extrusion of the helix of the atrial lead through the right atrial wall ( Figs. 1 and 2 ). Transthoracic echocardiogram revealed no evidence of pericardial effusion. A chest tube was inserted to drain the pneumothorax. The atrial lead was successfully extracted percutaneously with surgical backup readily available, and a new lead was implanted without complications.
