Case report describes a patient with permanent pacemaker (implanted in childhood) who has developed infectious endocarditis with bacterial vegetation on the stimulation electrode while no febrile condition occurred and laboratory tests showed no inflammation. The course of the disease was affected by the previous inappropriate outpatient treatment of an infection in the suture after the pacemaker exchange. It should be noted that echocardiographic examination was essential for both the diagnostics and the choice of strategy. The therapeutic approach consisted of the combination of long-term antibiotic therapy and the explantation of the infected stimulation system. As it was not possible to accomplish by endovasal methods only, cardiosurgery for extraction of the lead was chosen.

        Key words: permanent pacemaker, infection, echocardiography, extraction.