Cardiac metastases are a rare clinical entity and they generally portend a poor prognosis. Management is generally directed toward symptom control and maintaining cardiac function; however, long-term survival is rare. Here, we report a case of isolated metastatic urothelial cell carcinoma to the right ventricle that was functionally limiting the patient. The metastasis was successfully palliated for 17 months following radiation and immune therapy; however, disease progression in and around his heart ultimately led to a cardiac arrest.