Objective:To explore the postoperative electrocardiogram characteristics and its clinical significance in patients who had undergone orthotopic heart transplantation with double vena cava anastomosis .Methods :The electrocardiogram results of 70 patients during postoperative follow‐up ,who underwent orthotopic heart transplantation with double vena cava anastomosis in Zhongshan Hospital ,Fudan University from 2009 to 2012 ,were retrospectively analyzed .Results:The patients’ average ventricular rate was a bit faster than normal after operation ,and the common phenomena of electrocardiogram were non‐ischemic ST‐T changes ,increasing P terminal force in lead V1(Ptfv1) and incomplete right bundle branch block(IRBBB) .The rare phenomena such as slow ventricular rate ,ischemic ST‐T changes and arrhythmia ,however ,indicated poor prognosis . Conclusions : The postoperative electrocardiogram characteristics in patients who have undergone orthotopic heart transplantation with double vena cava anastomosis are conducive to predicting the patients ’ prognosis .