The incidence of cardiac perforation after temporary pacemaker (TP) implantation is very low. Severe consequences including cardiac tamponade and death may occurred when cardiac perforation. We present a case of an 89-year-old man patient with progressive chest tightness and dyspnea soon after TP implantation. Chest radiography revealed right ventricular (RV) lead migration and emergent unenhanced chest computed tomography (CT) demonstrated the RV lead perforated the right ventricular wall into the pericardium. Emergent open-heart surgery confirmed RV perforation.