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Extravascular cardiac resynchronization therapy (CRT) defibrillators (CRT-Ds) are ideal for recurrent blood stream infections. Furthermore, CRT is useful for patients intolerant to right ventricular (RV) pacing. The case was a 65-year-old man with a CRT-D who presented with a blood stream infection. Because he was hemodynamically unstable with temporary RV pacing, an epicardial CRT device was re-implanted concomitantly through a surgical procedure. After the operation, a subcutaneous implantable cardioverter defibrillator (S-ICD) was p