Congestive heart failure and supraventricular arrhythmias are common cardiac conditions that often coexist and make the treatment of the other more challenging. Current evidence supports aggressive pursuit of normal sinus rhythm in cases where CHF and LV dysfunction is likely to be acute and directly precipitated by persistent tachycardia. Radiofrequency ablation of the arrhythmia substrate is indicated in most cases of classic SVT including atrioventricular node re-entrant tachycardia, atrioventricular re-entrant tachycardia and focal automatic atrial tachycardia where cure of the arrhythmia is the norm. In cases of atrial fibrillation and atrial flutter associated with CHF prevention of thromboembolic complications and adequate rate control is recommended. Patients who do not respond to rate control alone may be treated with alternative therapies including antiarrhythmic drug therapy, catheter or surgical ablation or atrioventricular node ablation with permanent biventricular pacing although the indications and outcomes of these therapies in patients with structural heart disease and CHF are not well investigated.