We report on 7 patients with pacemaker endocarditis diagnosed during the workup of long-standing fever. Persistent positive blood cultures and echocardiography led to the diagnosis in 6 patients whereas autopsy was diagnostic in another. Causative microorganisms were Staphylococcus epidermidis (3), Staphylococcus lugdunensis (1), Pseudomonas aeruginosa (1), Streptococcus bovis (1), and Streptococcus mitis-Streptococcus sanguis (1). Pulmonary embolism was present in nearly 50% of the cases, a figure clearly higher than previously reported. In all but 1 case the initial medical approach was not successful, and thus the pacing system was finally removed. None of the cases relapsed after the removal. We have reviewed the literature regarding pacemaker endocarditis, particularly with respect to treatment.