Kapa et al30 reported a 1.4% complication risk at Mayo Clinic. In summary, several factors associated with a greater risk of CIED infection have been described in this section, including the following: (1) Immunosuppression (renal dys- function and corticosteroid use); (2) oral anticoagulation use; (3) patient coexisting illnesses; (4) periprocedural factors, including the failure to administer perioperative antimicrobial prophylaxis; (5) device revision/replacement; (6) the amount of indwelling hardware; (7) operator experience; and (8) the microbiology of bloodstream infection in patients with in- dwelling CIEDs. Future study of CIED infection pathogene- sis should better define how associated factors contribute to infection risk and whether intervention can decrease the risk. Risk factor analyses reported to date have noteworthy limitations, generally have included relatively small numbers of patients with CIED infections, and, with few exceptions, reflect the experience of single centers. Thus, although the existing literature provides some insight into CIED infection risk factors, larger, more representative studies would be useful in identifying and addressing the most important factors that are responsible for the development of CIED infection. Financial Burden Precise data regarding the actual healthcare burden of CIED infections are not available and are sorely needed. Consider- ing the acquisition costs of CIED,31 it is not surprising that the economic consequences, including healthcare resource utili- zation, of CIED infections are substantial. The financial impact is due to multiple factors, including but not limited to the costs of device removal, a new device (which would be required in the majority of patients), cardiac and other medical evaluations, diagnostic procedures, surgical interven- tions for infected device removal, new device placement and certain infectious complications, medical therapy of infec- tion, and critical care stays that are often prolonged. 