Kyong Joo Lee, et al. tricular node dysfunction, rate-responsive atrial pacing should be considered in majority of cases. However, consi- dering the possibility of surgical trauma around superior vena cava at the time of transplantation in our case, we decided single lead pacemaker insertion (VVI) to prevent the opportunity of complication such as thrombosis. In conclusion, the present case represents a permanent pacemaker insertion for syncope due to sinus arrest after heart transplantation, even with bicaval technique, which has been known to associate with few incidences of sinus node dysfunction. REFERENCES 1. Parry G, Holt ND, Dark JH, McComb JM. Declining need for pacemaker implantation after cardiac transplantation. Pacing Clin Electrophysiol 1998;21:2350-2. 2. Blanche C, Valenza M, Aleksic I, Czer LS, Trento A. Technical considerations of a new technique for orthotopic heart transplan- tation. Total excision of recipient’s atria with bicaval and pulmo- nary venous anastomoses. J Cardiovasc Surg (Torino) 1994;35: 283-7. 3. Lower RR, Shumway NE. Studies on orthotopic homotrans- plantation of the canine heart. Surg Forum 1960;11:18-9. 4. Yacoub M, Mankad P, Ledingham S. Donor procurement and surgical techniques for cardiac transplantation. Semin Thorac Cardiovasc Surg 1990;2:153-61. 5. Sarsam MA, Campbell CS, Yonan NA, Deiraniya AK, Rahman AN. An alternative surigical technique in orthotopic cardiac tran- splantation. J Card Surg 1993;8:344-9. 6. Meyer SR, Modry DL, Bainey K, Koshal A, Mullen JC, Rebeyka IM, et al. Declining need for permanent pacemaker insertion with the bicaval technique of orthotopic heart transplantation. Can J Cardiol 2005;21:159-63. 7. Heinz G, Hirschl M, Buxbaum P, Laufer G, Gasic S, Laczkovics A. Sinus node dysfunction after orthotopic cardiac transplantation: postoperative incidence and long-term implications. Pacing Clin Electrophysiol 1992;15:731-7. 8. Melton IC, Gilligan DM, Wood MA, Ellenbogen KA. Optimal cardiac pacing after heart transplantation. Pacing Clin Electro- physiol 1999;22:1510-27. 9. Rothman SA, Jeevanandam V, Combs WG, Furukawa S, Hsia HH, Eisen HJ, et al. Eliminating bradyarrhythmias after orthotopic heart transplantation. Circulation 1996;94 (9 Suppl):II278-82. 590 Yonsei Med J http://www.eymj.org Volume 50 Number 4 August 2009