Infectious complications following pacemaker implantation are not common but can be particularly severe. The reported incidence varies from 0.5 to 5% in the literature. The duration of the procedure and repeat procedures are considered to be predisposing factors. The main cause of these infections is thought to be local contamination during the implantation. The commonest causal organism is staphylococcus. Because the presentation may be atypical, the diagnosis is often confirmed by transesophageal echocardiography which is the investigation of choice for imaging a vegetation on an endocavitary pacing lead in cases of infectious endocarditis. The seriousness of this infection requires early diagnosis and adapted treatment including double bactericidal antibiotherapy and complete ablation of the material. Systematic preoperative prophylactic antibiotic therapy is recommended.