The authors reported a case of traumatic implantable cardioverter defibrillator (ICD) lead perforation of the right ventricular (RV) apex caused by a motor vehicle accident. Clinical and echocardiographic features combined with changes in electrical parameters of the offending lead were decisive for the final diagnosis. Optimal management of ICD lead RV wall perforation is currently unclear. In our report, RV perforation was responsible for cardiac tamponade. This complication was uneventfully managed by open surgical procedure.