Background Three‐dimensional electroanatomic mapping systems (3D mapping) allow the creation of an anatomic representation of the cardiac anatomy and real‐time monitoring of transvenous pacing catheters. Their use to facilitate pacemaker (PM) and implantable cardioverter defibrillator (ICD) lead placement in the pediatric population has not been well defined. We sought to review our experience using 3D mapping as an adjunct to fluoroscopy for positioning of permanent PM and ICD leads in pediatric patients. Methods We performed a retrospective review of all patients ≤21 years of age who underwent PM or ICD implantation with the aid of the Ensite Velocity system (Ensite) from May 2012 to September 2014. Fluoroscopy was utilized in addition to 3D mapping to aid obtaining vascular access, to visualize fixation of the lead to the myocardium, and to evaluate lead length within the vasculature. Results Nineteen patients (mean age 14.6 ± 4.4 years) underwent placement of active fixation PM leads (N = 17) and/or ICD leads (N = 10) with the aid of Ensite. All leads were successfully placed (eight atrial, 19 ventricular). Fluoroscopic exposure was a mean of 3.2 minutes (± 2.8, 0.1–10.5). There was one lead dislodgement. Conclusions Ensite was used successfully as an adjunct to fluoroscopy in all patients in whom it was attempted to aid the placement of permanent transvenous PM and ICD leads. Future evaluation could focus on the use of 3D mapping systems to further minimize or eliminate fluoroscopy from PM and ICD implantations.