BACKGROUND: Cryoablation for pediatric atrioventricular nodal reentry tachycardia (AVNRT) is favored for reducing conduction system injury compared to radiofrequency (RF) ablation. The safety advantage of cryoablation over RF ablation primarily results from studies conducted without a three-dimensional electroanatomical mapping (3D EAM) system. Currently, 3D EAM systems offer precise and efficient guidance, improving safety and outcomes. This study compares RF ablation and cryoablation using a 3D EAM system for pediatric AVNRT treatment. METHODS: A retrospective study enrolled consecutive pediatric patients with AVNRT who underwent RF ablation (RF group) or cryoablation (Cryo group) guided by a 3D EAM system at multiple centers from July 2018 to January 2024. RESULTS: Among 95 patients, 69 received RF ablation and 26 received cryoablation. Recurrence rates were 2.9% in the RF group and 0% in the Cryo group ( CONCLUSION: With 3D EAM guidance, both RF ablation and cryoablation are considered safe and effective for pediatric AVNRT. RF ablation is more efficient with a shorter procedure time after increasing experience.