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Nine patients paced with an indwelling catheter as a preoperative measure prior to synchronous pacer implantation were observed at surgery to have catheter perforation into the pericardium within 1 to 14 days. Such perforation may result from mechanical systole when the catheter tip becomes fixed in the trabeculae carneae of the right ventricular outflow tract and is progressively forced through the thin myocardial wall. Stimulation may be uninterrupted, intermittent, or absent in the presence of catheter perforation. Since hemopericardium has been observed without symptoms or radiologic evidence, the physician should be aware of this possible complication and its potentially serious effect.

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