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. Long-term stable recipient sinus node function may, therefore, be maintained in some cardiac transplant recipients with standard atrio-atrial anastomes. Atrio-atrial pacing may be feasible and effective years after transplantation.