A 44-year-old man developed recurrent pulmonary embolization after implantation of a permanent transvenous DVI pacemaker connected to polyurethane leads. Thrombus was found in the left innominate and subclavian veins around the pacemaker leads, but not in the right atrium or in the venous system of the pelvis and the lower extremities. The recurrence of pulmonary embolization followed discontinuation of treatment with Coumadin. This case demonstrates that lifelong anticoagulation is indicated in patients who have had pulmonary embolization and/or venous thrombosis around the pacemaker leads.