As part of our first Pediatric EP blog, it is timely to be able to report on the recent 5th Charleston Symposium on Pediatric Electrophysiology, which took place December 13-15, 2009, in Charleston, South Carolina. Based on feedback from prior years and an interest in keeping the course updated over time, this year’s program was somewhat different by focusing primarily on how to make decisions on care rather than the technical aspects of delivering care. To that end, most of the talks were preceded by a case report that demonstrated the complexity of decision making in the relevant topic and posed a set of questions for the speaker. Apparently, our brochure “sold” this concept well, because of the 100 or so attendees, over half were a mix of non-electrophysiologists, including pediatric cardiologists, adult cardiologists and nurse practitioners. Attendees came from all over the U.S., as well as Japan and five countries in Europe.