Indications for cardiac pacing in pediatric patients continue to expand. In addition to its traditional use in sinus and atrioventricular nodal disease, applications for cardiac pacing now include treatment of tachyarrhythmias after repair of congenital heart disease, reduction of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy, and prevention of sudden death in the congenital long QT syndrome. Whereas many benefits have been well documented in adults, they remain anecdotal in children. Programmable features such as rate-response and antitachycardia pacing contribute to pacemaker versatility and facilitate the achievement of normal hemodynamics in children requiring long-term pacing therapy.