Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Even though randomized trials are not available, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. In 2003, the ACCF/AHA Task Force on Practice Guidelines developed a list of suggested phrases to use when writing recommendations. All guideline recommendations have been written in full sentences that express a complete thought, such that a recommendation, even if separated and presented apart from the rest of the document (including headings above sets of recommendations), would still convey the full intent of the recommendation. It is hoped that this will increase readers comprehension of the guidelines and will allow queries at the individual recommendation level. Baddour et al Cardiovascular Device Infections 459 Guidelines from the American College of Cardiology/Amer- ican Heart Association/Heart Rhythm Society are available and are updated serially; the guidelines provide specific recommendations for CIED implantation.3 In an analysis4 of CIED implantation in the United States between 1997 and 2004, implantation rates for PPMs and ICDs increased by 19% and 60%, respectively. Approxi- mately 70% of device recipients were 65 years of age or older, and more than 75% of them had 1 or more coexisting illnesses. These data are consistent with findings from recent population-based surveys in Olmsted County, Minnesota,5,6 where patients undergoing PPM implantation between 1975 and 2004 had increasing numbers of coexisting illnesses. Simultaneously, dual-chamber pacing has become used much more frequently than single-chamber pacing.4 Similarly, the frequency of ICD implantation increased in the elderly (70 to 79 years of age) and very elderly (80 years of age or older).5 The 2001 World Survey7 found that in developed countries, between 20% and 35% of CIED recipients were more than 80 years old. 