Silka et al115 described 125 pediatric patients with 4 ICD wound infections and 2 pocket erosions. A erosions in the first 30 days after device implantation and 13 (2.9%) chronic infections among 443 patients. One study116 compared ICD complications between adults and pediatric patients ( 21 years of age) at the same institution. The infection rate in the pediatric group was 18% (2 of 11) compared with epicardial and 1 transvenous system infection in the pediatric group. There was no specific information provided in the report to indicate how many of the systems in adults were epicardial.117 The authors speculated that pediatric patients may have had a higher infection rate due to returning to activity sooner and less than optimal wound care. The same principles of diagnosis and management of device infections in the general population apply to pediatric and congenital heart disease patients; however, there are some additional considerations. The excellent imaging provided by standard transthoracic echocardiography may supplant the need for a transesophageal study in some pediatric patients. Because of the high prevalence of nontransvenous systems and the unique configurations required to implant CIEDs in some pediatric patients and individuals with congenital heart disease, there must be a thorough evaluation of the need to remove all components of a device. This includes a review of a patient s ongoing need for the device; if the device therapy is no longer required, it should be removed. Epicardial and other nontrans- venous systems in use can necessitate extensive surgical proce- dures for complete device removal, including a full or limited sternotomy or thoracotomy. Therefore, the suspicion of device- component infection must be balanced against the risk of surgical removal. 