Bradyarrhythmia after heart transplantation. Incidence, time course, and outcome.
 From June 1980 to April 1989, 72 of 401 (18%) adult recipients of orthotopic heart transplantation developed prolonged (greater than 24 hours) bradyarrhythmias (less than 60 beats/min) within 5 days after transplantation.
 Junctional bradycardia occurred in 50 (69%) recipients, sinus bradycardia in 18 (25%), and slow ventricular response during atrial fibrillation in four (6%).
 Fifty-five of 72 (76%) patients had bradyarrhythmias of less than 20 days' duration (less than 7 days, 50 patients; 7-20 days, five patients).
 Fifty patients returned to sinus rhythm (greater than 60 beats/min) by the time of discharge.
 Five patients expired within 20 days.
 Seventeen of 72 (24%) patients had bradyarrhythmia for more than 20 days, which was symptomatic in 11.
 All 17 patients (junctional bradycardia, 13 patients; sinus bradycardia, four patients) received a permanent pacemaker within 40 days after transplantation.
 Between 1 and 12 months (mean, 4 +/- 3 months) after pacemaker implantation, 12 patients recovered sinus rhythm (greater than 70 beats/min).
 The other five patients had intrinsic rates of 32-57 beats/min (mean, 48 +/- 10 beats/min) during 1-9 months (mean, 4 +/- 3 months) of follow-up.
 The donor ischemic time in bradyarrhythmia patients was 202 +/- 34 minutes, which was significantly longer (p less than 0.01) than the 173 +/- 43 minutes for those patients without bradyarrhythmia.
 Conclusively, the incidence of posttransplantation bradyarrhythmia is relatively high.
 It is usually temporary, however, even in patients with a prolonged duration of bradyarrhythmia.
 A relation appears to exist between donor ischemic time and the incidence of bradyarrhythmia.
