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Bring a large pot of salted water to a boil for cooking the fettuccine.
While the pasta water is heating up, on a microwave-safe plate, microwave the frozen meatballs for 1 minute on high.
Add the olive oil to a large skillet over medium heat. Once the oil shimmers, add the meatballs. Cook until lightly browned, about 1 minute on each side, then turn off the heat. Place the meatballs on a plate, and set aside.
Drain any extra grease from the skillet into a small bowl so it can cool before you toss it.
Add the pasta to the boiling water and cook according to package instructions.
While the pasta is cooking, turn the heat under the skillet to medium-low. Add the heavy cream and cook, stirring occasionally, until steaming, about 3 minutes.
Add the pesto, salt, and pepper, and stir to combine. Add the meatballs back in and stir to coat them in the sauce.
Increase the heat to medium and cook, stirring frequently, until the meatballs are cooked through (they should reach an internal temperature of 165°F), about 7 minutes.
If the sauce starts to boil, lower the heat. You want a steady simmer, not a boil.
Drain the cooked pasta and add to the skillet. Use tongs to coat the noodles fully in the sauce, then remove from the heat and serve immediately.