Implantation is usually postponed to allow for resolution of infection, but patients who are PPM dependent represent a challenge, because they cannot be discharged home with a temporary pacemaker. Because of complications with passive-fixation leads that have been used in the past for temporary pacing in CIED infection cases, active-fixation leads attached to pacing gen- erators or defibrillators are now being used as a bridge until PPM implantation is deemed appropriate. Use of active- fixation leads connected to external devices in stimulation- dependent patients with infection permits earlier mobilization of the patient and has been associated with a reduced risk of pacing-related adverse events, including lead dislocation, resuscitation due to severe bradycardia, and local infection.77 The optimal timing of device replacement is unknown. Some have advocated proceeding 24 hours after remo- val.23,38,71,78 Sohail et al38 demonstrated a difference in timing of replacement based on (1) blood culture results (median time of 13 days for bacteremic patients versus 7 days for nonbacteremic patients) and (2) type of pathogen identified (median 7 days for CoNS versus 12 days for S aureus). There have been no prospective trial data that examined timing of new device replacement and risk of relapsing infection; however, several investigators recommend waiting for blood cultures to be negative before a new device is placed23,38,71 (Figure 2B). Only 1 medical center has described simultaneous contralat- eral (side-to-side) replacement of an infected CIED.79 A 1-stage exchange was performed in 68 consecutive patients over almost a 14-year period by 1 cardiologist, and two thirds of patients had dual-chamber devices. Clinical presentations included device erosion (41%), cellulitis or abscess (35%), and endocarditis (24%). 