Late lead perforation presenting as acute shoulder pain.

Pacemaker lead perforation is a rare but important complication with an incidence of less than 1%. Late lead perforation is defined as the perforation of a device lead through the myocardium more than 30 days after implantation. Here we present a case of late lead perforation which presented with sudden onset of severe left shoulder pain. This case illustrates the unusual presentation of a delayed pacemaker lead perforation.