Transesophageal atrial pacing was used in 29 consecutive patients aged 1 day to 16.5 years (mean 8.04 years) to replace the following procedures: intracardiac electrophysiologic study in patients with selected arrhythmias (21 patients), intracardiac overdrive or synchronized direct current cardioversion of supraventricular tachyarrhythmias or drug administration in patients with acute reciprocating supraventricular tachycardia (9 patients). Atrial capture was achieved without discomfort in 27 patients (93.1%). The diagnostic or therapeutic goal of the procedure was achieved in 26 children (89.7%). Transesophageal atrial pacing may replace intracardiac pacing procedures, direct current cardioversion and drug administration in patients with selected cardiac arrhythmias and has proved appropriate as a first diagnostic or therapeutic step.