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We present a case of post herpetic neuralgia in a patient admitted with a prior herpetic infection complicated by recurrent episodes of asystole and cardiac arrest. We first tried medical therapy with the use of high doses of intravenous analgesics, opiates, carbamazepine and phenytoin. However, the high recurrence rate of the pain episodes with concomitant cardiac arrest and cardiopulmonary resuscitation warranted first the placement of a temporary pacing lead, and shortly after a permanent device as a rescue procedure. This case illustrates the treatment difficulties in such an uncommon and extreme situation.