OBJECTIVE--To assess the incidence and complications of permanent pacing in patients who undergo tricuspid valve replacement. DESIGN--A retrospective study of records of patients who had a tricuspid valve replacement between 1978 and 1993 at the Middlesex hospital. RESULTS--45 patients with tricuspid valve replacements were followed up for a total of 104 patient years. Ten patients (22%) required permanent pacing, five with epicardial leads and five with endocardial. Endocardial leads had significantly lower initial implantation thresholds and were associated with fewer complications. CONCLUSION--Patients undergoing tricuspid valve replacement frequently require permanent pacing. Endocardial or epicardial lead insertion should be considered at the time of tricuspid valve replacement.