Paroxysmal supraventricular tachycardia (PSVT) is a clinical syndrome characterized by a rapid tachycardia with an abrupt onset and termination cardiomyopathy. The three most common causes of PSVT are atrioventricular nodal reentrant tachycardia (50%-60%), atrioventricular reentrant tachycardia in patients with Wolff-Parkinson-White syndrome (25%-30%), and atrial tachycardia (10%). Rare causes of PSVT include focal junctional tachycardia, atriofascicular tachycardia, permanent reciprocating junctional tachycardia, and nodoventricular/nodofascicular tachycardia. This article, based on challenging PSVT cases, is a guide for clinicians dealing with diagnostic or therapeutic dilemmas in the electrophysiology laboratory.