Despite the ever shrinking size of devices and our greater technical expertise, there has been a disproportionate rise in the rate infections associated with cardiac devices. Drs Raul Espinosa and M Rizwan Sohail join Dr Charanjit (Chet) Rihal to discuss the possible explanations and best known measures to keep infection at bay. They review types of infections, how diagnosis is made, the thorny issue of TEE, and practical suggestions for extraction and reimplantation of devices.