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This case details the successful implantation of a leadless pacemaker following the extraction of transvenous leads in a 72-year-old female patient with a complex cardiovascular history. The patient had undergone a series of cardiac interventions, including a recent percutaneous tricuspid valve repair with a metal clip implant due to severe regurgitation. After presenting with an infection at the pacemaker site, methicillin-resistant Staphylococcus hominis was identified, necessitating the removal of the entire pacing system. A leadless pacemaker was subsequently implanted without complications, despite the recent tricuspid valve repair. This case highlights the efficacy and safety of leadless pacemakers in complex clinical scenarios, especially when traditional transvenous systems are no longer viable due to infections or other complications. The report underscores the importance of personalized management strategies for cardiac device infections, illustrating that leadless pacemakers offer a feasible and safe alternative even in patients with previous valvular interventions. SUMMARY: The increasing rate of cardiac implantable electronic devices (CIED) implantations and of CIED-related complications highlight the importance of transvenous lead extraction (TLE). TLE scenario is constantly evolving and it is a key procedure in lead management strategies. Leadless pacemaker (LP) implant is an effective and safe procedure in patients still requiring a ventricular pacing after TLE, with similar electrical performance and outcome compared with naïve patients at long-term follow-up. LPs represent an innovative and feasible option even in specific situations such as after transcatheter tricuspid valve repair., (© 2025 Wiley Periodicals LLC.)