They speculated that several factors could be operative in causing an increased infection rate among younger patients, including a higher rate of reinterventions at the generator site, placement of a relatively larger device based on a higher ratio between the volume of the generator and body size, and the likelihood of local trauma to the generator site in younger, Baddour et al Cardiovascular Device Infections 469 more active individuals. A number of studies86,106 114 of infected PPMs in the pediatric population have demonstrated that congenital heart disease is present in a large percentage (44% to 83%) of young patients, with overall infection rates that ranged between 1% and 8%. Patients with endocardial and epicardial leads composed 70% and 30%, respectively, of reported cases. With the exception of 1 study, there were no differences in rates of epicardial and transvenous pacemaker infections. In the largest review of pediatric pacemaker infections, Cohen et al90 analyzed 385 pacemaker procedures over a 20-year period and identified 30 infections (7.8%). Of these infections, 19 (4.9%) were superficial and were treated successfully with antibiotics only, whereas 9 (2.3%) were deep pocket infections that required removal of the generator and leads. By multivariable analysis, the only risk factors for infection were the presence of Down syndrome and reinter- vention for revision of the pacing system. Although the numbers were small, the authors suggested that a subpectoral placement of a device yielded a reduced infection risk compared with a prepectoral location. No study has compared rates of pacemaker and ICD infec- tions in a pediatric population, although several investigations have examined pediatric and congenital heart disease patients after ICD implantation. Silka et al115 described 125 pediatric patients with 4 ICD wound infections and 2 pocket erosions. 