Very late-onset atrial lead perforation leading to pneumopericardium.

Background: Atrial lead perforation may lead to pneumopericardium or pneumothorax within a few days of device implantation. Methods and

Results: We report a case of atrial lead perforation 6 years after cardiac resynchronization therapy implantation, which resulted in pneumopericardium and pneumothorax.

Conclusion: Although pneumopericardium caused by atrial lead perforation can spontaneously resolve with conservative treatment, as it did in this case, treatment should be decided based on the patient's general condition and lead performance.