A 71-year-old man was admitted to our department with suspected pacemaker endocarditis because of unexplained fever and Staphylococcus epidermidis bacteremia. The patient’s history revealed a double-chamber pacemaker implantation 7 years ago for third-degree atrioventricular block. Transesophageal echocardiography showed a significant thickening of both leads associated with a mobile 2.7-cm vegetation on the ventricular lead. A patent foramen ovale was also noted on transesophageal echocardiography (Figure 1; supplemental Movie I). The diagnosis of endocarditis was thus confirmed, and percutaneous lead extraction was planned under antibiotic therapy with prior epicardial implantation. The extraction procedure was performed by lead traction associated with a laser sheath for both the auricular and ventricular leads. The immediate …