Since the effects of bradycardia after cardiac transplantation are not known, we tested the hypothesis that perioperative bradycardia would lead to an increase in adverse outcomes after cardiac transplantation. We conducted a retrospective case control study with inclusion criterion of a heart rate (HR) less than 80 bpm during the 1st week after transplantation. Control patients were matched for gender, age and time since transplantation. We identified 34 patients as having perioperative bradycardia out of the 174 who underwent cardiac transplantation between 1994 and 1997. The results demonstrated no significant differences in donor ischemic times (180 vs. 183, p = 0.88), operative surgeon (p = 0.62) or pretransplant cardiac disease (p = 0.81) between groups. Bradycardic patients were more likely to be on pretransplant amiodarone (RR = 20.4, p < 0.001). Perioperative bradycardia did not lead to increases in cellular rejection (p = 0.72) or vasculopathy (p = 0.79). The patients prescribed pretransplant amiodarone (n = 14) had a trend toward delayed time to first rejection episode (31.0 vs. 15.5days, median, p = 0.07). In conclusion, perioperative bradycardia does not increase adverse outcomes after cardiac transplantation and is associated with pretransplant use of amiodarone. Amiodarone may modify the recipients' immune response by delaying the occurrence of rejection.