Medically refractory tachyarrhythmias remain a significant clinical problem. The indications for surgical intervention in this challenging patient population continue to expand. Advances in noninvasive detection of patients at risk, as well as expanding electrophysiologic testing, continue to help define patients best served by surgical therapy. Refinements in surgical techniques, including rapid computerized intraoperative arrhythmia mapping, have made operative therapy safer and more effective. This review describes recent observations and advances in surgical therapy for supraventricular and ventricular tachyarrhythmias.