A 45-year-old woman with previous repair of coarctation of aorta, ventricular septal defect closure, and progressive decline in her exercise capacity was admitted for the treatment of left leg deep venous thrombosis (DVT). She had a history of complete heart block and insertion of a pectoral pacemaker. After numerous problems with pocket infections, multiple box changes and fracture of the atrial lead, the pectoral system was extracted, and a transfemoral permanent pacemaker was implanted. Even though transfemoral pacing is considered a safe alternative to epicardial lead placement, this may not be the case in functionally impaired patients with mobility problems. Physicians caring for such patients should be alert to symptoms of DVT and provide prompt treatment to avoid major complications. © The European Society of Cardiology 2007. All rights reserved.
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