In patients with advanced esophageal cancer, management of dysphagia is a challenge with significant implications on patient quality of life. Brachytherapy has been shown to be an effective and safe treatment option for symptoms related to dysphagia. The effect of endoscopic brachytherapy on patients with a cardiac implantable electronic device has not previously been described in literature. We present an 89-year-old female with a dual chamber permanent pacemaker who elected to undergo palliative brachytherapy delivered via endoscopy for treatment of dysphagia secondary to locally advanced esophageal adenocarcinoma.