Late atrioventricular block and permanent pacemaker implantation after heart transplantation

The need for permanent pacemaker implantation due to late atrioventricular (AV) block after heart transplantation is rare. A 59-year-old male patient underwent heart transplantation. He presented with syncope eight months after transplantation. Ambulatory 24-hour Holter monitoring showed predominant sinus rhythm with a mean heart rate of 74 bpm, intermittent second-degree AV block, and high-degree AV block with pauses of up to 10.6 seconds. Percutaneous transvenous endomyocardial biopsy yielded a histologic diagnosis of grade IA rejection according to the ISHLT (International Society of Heart and Lung Transplantation) scoring system. A permanent pacemaker with DDD-R mode was implanted via the left subclavian vein, and he was discharged on the following day without any complication.