A Misleading Case of Persistent Chest Pain.

Cardiac wall perforation is a recognized complication of pacemaker lead fixation. It is typically associated with deterioration of electrical parameters; however, this case demonstrates that perforation may occur despite normal parameters and apparently normal device function. In patients with recent cardiac electronic device implantation, persistent or pleuritic chest pain should raise suspicion of myocardial perforation. Transthoracic echocardiography may be diagnostic, and cardiac computed tomography provides definitive confirmation when uncertainty remains.