Introduction:
Recently, leadless pacemaker emerged as a new pacing strategy to avoid pocket and lead-related complications as compared with conventional pacemaker1. However, though the incidence of major complications was demonstrated to be low to 1.51% in Micra transcatheter pacing system (TPS) (Medtronic, Minneapolis, MN, USA)2, cardiac perforation remains a major safety concern with the incidence of about 0.13%~1.3% in studies2,3. Herein, we presented a case of cardiac perforation with pericardial tamponade caused by accidently placing the delivery catheter into the coronary sinus.