In particular, CIED infections have received the bulk of the attention, with sentinel observations regarding the epidemi- ology, associated risk factors, and management and preven- tion of permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) infections. Findings from several key clinical investigations that were published after 2003 prompted the Rheumatic Fever, Endocarditis, and Ka- wasaki Disease Committee of the Council on Cardiovascular Disease in the Young of the American Heart Association to provide an updated document limited to CIED infections. Because of the rarity of infection of implantable loop rec- orders and cardiovascular monitors, these devices are not considered in the present document. Classification System The writing group was charged with the task of developing evidence-based recommendations for care and designating a classification and a level of evidence for each recommendation. The American College of Cardiology/American Heart Associa- tion classification system was used as shown in Table 1. Background CIEDs have become increasingly important in cardiac disease management over the past 5 decades in the United States and have dramatically improved both patient quality and quantity of life. PPMs have been implanted since the 1960s. Advances in PPM technology have provided a strong foundation for the accelerated development of ICD and cardiac resynchroniza- tion systems.2 Over the years, CIEDs have become smaller in size despite a marked expansion of device functionality. Table 1. Applying Classification of Recommendations and Level of Evidence *Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as gender, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. 