We report the case of a 47-year-old male patient with a history of tetralogy of Fallot surgically corrected in childhood using the Waterston-Cooley and Cooley techniques. In adulthood, he developed severe pulmonary insufficiency, treated percutaneously with the implantation of a bioprosthetic valve. The patient was admitted for an elective surgery procedure. Following the administration of spinal anesthesia, ECG monitoring revealed the onset of atrioventricular block progressing to asystole, requiring immediate external cardiac massage. During the subsequent period, the patient also experienced a 5 s third-degree atrioventricular block associated with dizziness following carotid sinus massage. After multidisciplinary evaluation, the decision was made to implant a leadless pacemaker (Abbott Aveir VR). The procedure presented technical challenges, primarily due to the altered cardiac anatomy resulting from the underlying congenital heart disease and previous surgical corrections. Despite these difficulties, successful implantation was achieved. To our knowledge, this represents one of the few reported cases in the literature of leadless pacemaker implantation in a patient with corrected congenital heart disease. Given the absence of standardized procedural guidelines for such complex cases, we present our experience and discuss the associated technical considerations.