A 70-year-old woman was admitted for end-stage heart failure and cardiogenic shock, which required the implantation of a left ventricular assist device (LVAD, Heartmate 3, Abbott, St. Paul, MN, USA) as a bridge to transplant. During the hospital stay, she presented two episodes of paroxysmal complete atrioventricular block with prolonged asystole. No regular pacemaker could be implanted because of infectious contraindications and vascular access limitations. As a consequence, a leadless pacemaker was implanted and programmed in backup VVI mode at 50 bpm. This article is protected by copyright. All rights reserved.