Background <p>Electrical device therapy is increasingly used for paediatric patients with congenital and acquired arrhythmias and heart diseases.</p> Objectives <p>This review evaluates the indications, strategies and limitations of this therapy in the young. Pacing and defibrillation systems in young patients should last longer than in adults. The paediatric population ranges from preterm newborns to young adults, and therefore recommendations and pacing strategies are variable. Recent guidelines have provided new and updated recommendations. Various systems have enhanced our ability to treat arrhythmias. Transvenous and epicardial pacing systems compete for primacy among children; transvenous and subcutaneous defibrillators among adolescents. Outcomes are good, but there are frequent complications.</p> Conclusion <p>Electrical device therapy in the paediatric population is effective and safe, but it needs to be adapted to the age, size, and pathophysiology patients.</p>