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Leadless pacemaker (LP) is reported to have serious complications including cardiac tamponade and ventricular perforation during and after implantation. We report a case of severe tricuspid regurgitation (TR) caused by papillary muscle rupture and hypoxia during LP re-implantation, which required surgical intervention. The patient was an 88-year-old man who had undergone LP implantation for complete atrioventricular block 2 years before. Due to the battery depletion, the additional LP was implanted. After the procedure, he developed persistent hypoxemia despite 9 l oxygen administration. He was hemodynamically stable. On the second postoperative day, a transthoracic echocardiogram revealed papillary muscle rupture of the tricuspid valve. A bubble test was performed, which revealed a right-toleft shunt through the patent foramen ovale (PFO). Tricuspid valve replacement and PFO closure were performed. The patient had a good postoperative course and was moved to cardiology department on postoperative day 14. We report this case with a review of the literature.