In 50 patients with acquired valvular heart disease, an epicardial atrial pacing electrode was placed in juxtaposition to the sino-atrial node for epicardial-atrial pacing in the early postoperative period. In ten patients countershock failed to convert atrial fibrillation and precluded atrial pacing, and 12 patients did not require this procedure. Epicardial atrial pacing was used in 28 patients. Satisfactory atrial pacing was established in 12 of 21 patients undergoing mitral valve surgery, ten of 20 patients receiving an aortic valve prosthesis, and six of nine patients undergoing multiple valve surgery. Control of atrial or ventricular ectopy was the indication for pacing in 22 patients, while sinus bradycardia with hypotension necessitated pacing in six. Atrial electrograms were diagnostically important in seven patients. All electrodes were removed prior to discharge from the hospital. There were no complications secondary to the use of the electrode. Temporary atrial pacing is a safe and useful adjunct in the early postoperative period in patients undergoing surgery for valvular heart disease.