Methods: Between February 1998 and August 2014, we retrospectively analyzed the data of 212 consecutive patients (147 males, 65 females; mean age 39.6±15 years; range 5 to 65 years) who underwent heart transplantation with biatrial cuff technique in our clinic. Baseline characteristics and postoperative data were compared among the patients who required a pacemaker or did not.

Results: The incidence of permanent pacing after heart transplantation was 6.4%. The most frequent reason for permanent pacing was symptomatic bradycardia. Previous cardiac surgery was associated with a non-significant trend toward a need for permanent pacing (p=0.056). The presence of a ventricular assist device was a found to be associated with both prolonged temporary and permanent pacemaker requirement after biatrial cardiac transplantation (p=0.021 and p=0.042, respectively).

Conclusion: Although bradyarrhythmia and need for temporary pacing were common in the early postoperative period, few of these patients needed permanent pacemaker implantation. The need for a permanent pacemaker seems to be more frequent after challenging operations, such as bridge to heart transplantation with a long-term ventricular assist device.