Subclinical cardiac perforation caused by a Micra™ leadless pacemaker.

A subclinical cardiac perforation by a device cup of the Micra™ transcatheter pacing system was suspected in a 78-year-old woman. During the procedure, the device cup was placed on the septum. The contrast media was injected before device deployment and remained outside of the myocardium. Later, a cardiac computed tomography scan visualized a protruded diverticular structure on the right ventricle. The contrast material remained in a pouch within the pericardium. To ensure the device is oriented away from the border between the right ventricular septum and the free wall, right anterior oblique view should be carefully reviewed before deployment.