Multiple advances in the understanding of arrhythmia mechanisms as well as the advent of new drugs and the radiofrequency catheter ablation have revolutionized the antiarrhythmic management in children. With the availability of these therapeutic options an improved knowledge of the treatment options, their indications and risks is required. Despite these improvements, supraventricular tachycardias remain an important and challenging problem, because of steadily growing numbers of children and adults presenting with complex supraventricular arrhythmias years after cardio-thoracic interventions.