Laparoscopic assisted surgeries in a patient with second degree heart block have an exponential risk of progression to complete heart block. Prognosis of a patient with AV node (nodal block) is usually benign and block distal to AV node (infranodal block) has a potential high risk of progression to complete heart block. Insertion of a pacemaker preoperatively remains a tricky situation even in distal AV node block. At our institute, a 75 year old male patient with second degree Atrioventricular (AV) block with left bundle branch block was scheduled to undergo laparoscopic assisted anterior perineal resection without prior pacemaker insertion. So, in this case report we would discuss how a case of second degree AV block with bundle branch block was managed safely under general anaesthesia without prior pacemaker insertion. Early recognition, and timely intervention by the anesthesiologist, cardiologist and surgical team can avoid unnecessary perioperative complications and also associated postoperative morbidity.