An 85 year-old man with permanent atrial fibrillation and previous inferior wall and right ventricle STEMI treated with percutaneous primary angioplasty in 2013, was referred to our attention to extreme low ventricular rate, daytime pauses of 6 seconds symptomatic for dizziness found in a ECG Holter registration. After the myocardial infarction, the patient developed a severe tricuspid regurgitation (TR) owing to annular dilatation from adverse right ventricular remodeling so, in June 2022, owing to high cardiac surgery risk, the patient was successfully treated with percutaneous transcatheter implantation of three TriClip NT devices on posteroseptal, anteroseptal and anteroposterior commissures. The degree of TR improved from severe to moderate with mild tricuspid stenosis. Permanent pacemaker implantation was indicated. We decided to implant a conduction system pacing lead (His-bundle pacing) mainly for 3 reasons: (1) the presence of three tricuspid clips would have made it very difficult to advance a ventricular pacing catheter through the neo-orifices of the valve; (2) the high risk of clip displacement during catheter maneuvering across the valve plane; (3) a physiologic pacing such as His-bundle pacing seemed more appropriate given the need for high rate of ventricular pacing, in order to avoid further worsening of ventricular function. A Medtronic 3830 ventricular lead was inserted via the axillary vein through the His-dedicated Medtronic deflectable sheat (SelectSite C304-HIS) and in right anterior oblique fluoroscopic view the lead was advanced into the right atrium and we looked for a His bundle potential. It was decided to use the deflectable introducer in order to reach the Koch triangle with fine and precise movements without even accidentally interfering with the clips. The lead tip was screwed to the antero-septal edge of Koch’s triangle, showing optimal parameters of sensing, impedance, and pacing thresholds. Paced QRS was narrow as spontaneous QRS and a selective His-bundle paced QRS was seen on 12-leads. The fluoroscopy time was 10.9 minutes and a Total Dose Area Product (DAP) of 1.9 mGy/m2. The patient was then discharged 2 days later, asymptomatic. At the 1-month and 6-months visits all the pacing parameters was in the normal range and optimal His-bundle pacing treshold. Our case report demonstrates that His-bundle pacing in a patient with a complex transcatheter edge-to-edge tricuspid valve repair could be a safe and feasible option.