In recent years, the rapid development of cardiovascular implantable electronic devices has brought great benefits to elderly patients with complex cardiovascular diseases, but at the same time, it has also brought great challenges to clinical anesthesia. In this case, a 75-year-old patient with pacemaker infection and severe left heart insufficiency, EF29%, was to be treated under general anesthesia with pacemaker infection debridement and temporary pacemaker implantation. After thorough preoperative evaluation and refined intraoperative monitoring and management, the surgery was successfully completed and the perioperative safety of the patient was guaranteed.