Palpitations are a common cause of complaint in the paediatric population and can be a reason of serious concern for children, adolescents and parents. Despite this, palpitations are known to have a benign prognosis, but still are cause of referral to the Emergency Unit (EU). The aim of the present retrospective study was to make a review of prevalence and long-term prognosis of emergency accesses for palpitations between 2009-2015. The study was conducted in the EU of the Paediatric Hospital “Burlo Garofolo”, Trieste, Italy. Despite a low prevalence of access to the EU, namely 0.1%, 96 patients in a time span of 7 years, 16.7% of patients (n = 16) had an underlying arrhythmic cause for the symptom. The presence of a heart rate above 150 beats per minute was highly suggestive of cardiac arrhythmia, more often of paroxysmal supraventricular tachycardia. As far as the long-term follow-up is concerned, 10.4% of patients (n = 10) received medical therapy and 6.2% (n = 6) underwent transcatheter ablation for supraventricular arrhythmia. In conclusion, palpitations turned out to be an infrequent cause of access to the EU. Nonetheless, 1 out of 6 patients requires long term medical therapy or percutaneous intervention.