Transient cardiac apical ballooning syndrome (TCABS) is diagnosed by transthoracic echocardiography demonstrating apical akinesis with left ventricular (LV) apical ballooning and preserved mid-to-basal LV systolic function, and left heart catheterization showing the absence of significant obstructive epicardial coronary artery disease. Presenting symptoms are suggestive of an acute coronary syndrome and electrocardiogram findings mimic acute myocardial injury. Right ventricular involvement has been reported. We describe a case of acute pacemaker dysfunction caused by the TCABS, which responded to conservative therapy.