Catheter ablation is a well-established treatment for drug refractory arrhythmia and intracardiac echocardiography is one of the tools used for this purpose. Despite a high volume of procedures performed worldwide the incidence of vascular complications still very low. We describe a case report of a percutaneous treatment to an inferior vena cava perforation by an intracardiac echocardiogram catheter after the failure of a conservative approach.