Although the lungs are the most commonly affected organ in sarcoidosis, about 25% of cases will have cardiac involvement, but most cardiac sarcoid is asymptomatic. Although not visible on a chest x-ray, non-caseating granulomas can involve the cardiac conduction system, which may result in fatal arrhythmias. In this case, the patient did have involvement of the cardiac conduction system, necessitating pacemaker placement.