Introduction: Endomyocardial fibrosis (EMF) is characterized by patchy fibrotic thickening of the endocardial and myocardial layers of the heart. Although Sinus node dysfunction and tachyarrhythmia - atrial fibrillation, ventricular tachycardia, have been commonly reported, complete heart block complicating EMF is rare. Transvenous pacing is technically limited by fibrotic obliteration of the affected ventricle that results in poor lead parameters, and alternative pacing strategy like epicardial pacing may be required in many. Methods and Results: We present two cases of EMF with complete heart block that were managed by left ventricular pacing through the coronary sinus. Conclusion: EMF provides unique challenges to endocardial pacing. Transvenous epicardial pacing through CS tributary using an LV lead can provide a safe and effective alternative mode of pacing with optimal long-term pacing outcome.