The use of pacemakers and defibrillators in the young patient with congenital heart disease is challenged by unique device indications and programming needs, patient age and size, access issues, venous compromise, age and disease specific indications.Even though these aspects have been acknowledged by the American Heart Association when the guidelines for device implantation were developed for adults, the unique and unusual aspects of device implantation in the young patient remain a challenge.In children, the technology of devices and leads needed has influenced the develooment of soecialized devices, addressing specific needs.