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Severe symptomatic sinus node dysfunction in obstructive jaundice is known but rarely encountered. Sinus bradycardia in these patients has been attributed to the effect of bile salts on sino-atrial node. We report a case of 49-year-old cachectic and icteric lady, with obstructive jaundice due to peri-ampullary mass, who was a surgical turn-down owing to symptomatic sinus node dysfunction associated with 6 s sinus pause and was referred for permanent pacemaker. The patient was managed with temporary pacemaker implantation followed by a successful Whipple’s procedure. Sinus rhythm was restored after 72 hours with decline of serum bilirubin level and an unnecessary permanent pacemaker implantation was avoided.