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Despite preserved left ventricular function, exercise capacity is often impaired after cardiac transplantation due to autonomic denervation of the donor's sinus node. We present our experience with atrio-atrial resynchronization in 2 pediatric heart transplant recipients. Both were highly active, suffered from chronotropic incompetence, and underwent successful atrial resynchronization with an objective improvement in exercise capacity, restoration of a physiologic chronotropic response, and resolution of dyspnea.

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