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A patient with complete atrioventricular block was fitted with a temporary endocardial pacing wire via a right subclavian percutaneous approach. The result was initially satisfactory, but within a few days radiography for left-sided chest pain showed pneumopericardium. A permanent epicardial pacing system was therefore substituted and she remained well for three months. She was then admitted for syncope: the pacemaker was failing to capture, and radiography showed pericardial and pleuraldoi:10.1136/bmj.283.6292.635 fatcat:5bg4fg32qbgrnmlvgiynjalb5q