Infectious complications of cardiovascular implantable electronic devices (CIED) have risen out of proportion to overall increases in use. Although CIED can provide potentially life-saving benefits, device-associated infections can be a devastating complication. This article examines the epidemiology and microbiology of CIED infection and reviews specific host and procedural risk factors. Recent advances in the diagnosis of CIED infections and the multifaceted approach required for successful management in this complex patient population are also considered.