If a permanent pacemaker lead is misplaced in the left ventricle (LV), the lead may interfere with normal functioning of the heart leading various complications, including heart rhythm problems and blood clots. In our case, the LV lead that passed through the patent foramen ovale and was misplaced into the LV was detected in a 78-year-old patient who presented with embolic stroke. Thrombus regression was achieved with anticoagulation, and then the lead extraction was planned. The lead extraction is a priority in acute cases; but it is not the primary approach in long-term leads that were misplaced into the LV. A patient-based individual approach should be preferred in such cases.
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