Stent graft repair of aortic pathology involving the distal aortic arch requires precise device deployment based on excellent imaging and stable hemodynamics. An inadequate proximal seal may result in a type I endoleak, which may require an additional device or even conversion to open surgery to control. This case report describes transvenous rapid pacing, a safe and reproducible technique to allow precise deployment or balloon dilation of a stent graft in the distal arch or proximal thoracic aorta.