The infection rate with these less extensive operations was lower ( 7%).15 In a study of all ICD primary implantations, replacements, and revisions at a single center, there were 21 ICD-related infections (1.2%) among 1700 procedures, affecting 1.8% of 1170 patients. Among 959 patients with long-term follow-up, the infection rate was 3.2% with abdominal and 0.5% with pectoral Despite the greater ease of device implantation with pectoral rather than other routes and increasing experience with implantation, the rate of CIED infection has been increasing. Cabell et al16 reported that among Medicare beneficiaries, the rate of cardiac device infections (PPMs, ICDs, valves, and ventricular assist devices) increased from a 124% increase during the study period. The rate of frank endocarditis was relatively unchanged (0.26 and 0.39 cases/ 1000 beneficiaries, respectively). These findings were mirrored when CIED implantations were analyzed in Olmsted County, Minnesota, from 1975 to 2004.17 A total of 1524 patients were included with a total person-time follow-up of 7578 years with device implanta- tion. The incidence of CIED infection was 1.9/1000 device- years (95% confidence interval [CI] 1.1 to 3.1), with an incidence of pocket infection alone of 1.37/1000 device-years (95% CI 0.62 to 0.75) and an incidence of pocket infection with bloodstream infection or device-related endocarditis of cumulative probability of CIED infection was higher among patients with ICDs than among those with PPMs. The National Hospital Discharge Survey8 similarly showed that between 1996 and 2003, the number of hospitalizations for CIED infections increased 3.1-fold (2.8-fold for PPMs and 6.0-fold for ICDs). The numbers of CIED infection related hospitalizations increased out of proportion to rates of new device implantation. Moreover, CIED infection increased the risk of in-hospital death by more than 2-fold. Risk Factors Several studies have identified characteristics associated with CIED infections. 