Figure 1. (A) Chest X-ray revealing the enlarged cardiac shadow, with the leads located within the range of the cardiac shadow. (B) CTA with sagittal multiplanar reconstruction showing the tip of the atrial lead displaced forward (arrow) and slightly beyond the edge of the epicardial fat pad (white dashed line). (C) Intraoperative image showing the tip of the atrial lead (in circle) protruded slightly through the atrial wall. (D) The tip of the atrial lead retracted into the atrium.