Objectives: This study sought to discover the incidence of permanent pacemaker (PPM) placement for atrioventricular conduction block (AV block) after operative repair of perimembranous ventricular septal defect (PMVSD) in a large multi-institutional database and in the subgroup of patients comparable to those considered for transcatheter device closure of PMVSD. Background: Atrioventricular conduction block is a complication of operative repair of PMVSD and of device closure of this defect. Earlier reports do not report the incidence of AV block by VSD type. Methods: The Pediatric Cardiac Care Consortium database was searched for all children who had operative PMVSD repair except those with abnormalities that increase risk of AV block. The patient group was searched for those with subsequent PPM placement for AV block. Demographic data and time to PPM placement were available for all patients. Results: Of 4,432 patients with PMVSD repair, 48 (1.1%) underwent PPM placement for AV block. The PPM group was more likely to have Down syndrome (41% vs. 18%; p < 0.001), was younger (mean age 14 vs. 26 months; p < 0.001), and had longer mean length of postoperative hospital stays (20 vs. 8 days; p < 0.001). The most significant risk factor for AV block was Down syndrome (odds ratio 3.62, 95% confidence interval 2.02 to 6.39; p < 0.005). Modal time to PPM placement was 7 days (range 0 to 4,078 days). Out of 1,877 patients comparable to those currently considered for device closure, 13 (0.8%) underwent PPM placement after PMVSD repair. Conclusions: Operative AV block and PPM placement occurred in 1.1% of patients in the total group and in 0.8% of patients comparable to those considered for device closure of PMVSD. A PPM placement is more likely in patients with Down syndrome. These data should be considered as devices are developed and in the future when counseling families about options for PMVSD closure.