A 76-year-old woman had a permanent transvenous DDDR pacemaker implanted for complete atrioventricular block. She was hospitalized 4 years later for recurrent transient ischaemic attacks related to dislodgment of the atrial lead into the left atrium through a patent foramen ovale. The patient was successfuly treated by transvenous extraction of the atrial lead. The follow-up has been uneventful 12 months after the procedure. Left atrially dislodged pacemaker leads have to be retracted under full anticoagulation.