Key Clinical MessageSympathetic crashing acute pulmonary edema (SCAPE) complicating pacemaker implantation is a very uncommon and dangerous occurrence. Following pacemaker implantation, patients need stringent monitoring, and compelling evidence about SCAPE treatment is required.AbstractSympathetic crashing acute pulmonary edema complicating a pacemaker insertion as the case in our patient is extremely rare. We report a case of 75‐year‐old man with a complete AV block, which requires urgent pacemaker implantation. Half an hour following the insertion of the pacemaker, an abrupt SCAPE emerged and the patient was incubated immediately.