Implantation of permanent pacemaker systems is associated with a low rate of complications. The case of a 72-year-old woman is described who suffered from a cluster of complications related to permanent pacemaker implantation. Besides major bleeding, requiring transfusion and pneumothorax, malposition of both pacemaker leads in the arterial system occurred, with the atrial lead screwed into the right coronary artery, with subsequent occlusion of the vessel and the ventricle lead placed in the left ventricle.