Challenges in pacing in right ventricular endomyocardial fibrosis: A case study

•Endomyocardial fibrosis is sometimes associated with conduction abnormalities and calcification.•Calcification in endomyocardial fibrosis makes fixation of pacemaker lead challenging.•Options in severe calcific endomyocardial fibrosis are left ventricular pacing through the posterolateral, anterior interventricular, and middle cardiac veins; another available option is epicardial pacing.•Surgical epicardial pacing can be challenging due to right ventricular failure and epicardial or pericardial calcification.