Temporary cardiac pacing is usually performed via transcutaneous patches or transvenous temporary wires. This is routinely practiced in emergency and nonemergency situations. However, it is increasingly more common to encounter patients with venous thrombosis; particularly in patients on hemodialyis who have end-stage renal disease or patients with other intravenous implantations. In this article, we describe a patient with very difficult venous access, who during a cardiac catheterization needed emergent cardiac pacing, and an alternate approach via the femoral artery was performed successfully.