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Use of cardiovascular implantable electronic devices (CIED) has been increasing exponentially in the last two decades and is a critical component in the management of patients with cardiac rhythm disturbances, heart failure and prevention of sudden death. Patients receiving CIED therapy are now older and have significant morbidities that have led to a disproportionate rise in device infections. Infection clearly reduces survival, carry high financial costs and is a challenging infective process that require expert multidisciplinary teams for an adequate management. Moreover, some aspects of diagnosis, treatment and prevention are still conflictive and a matter of debate. This review provides a comprehensive examination of several aspects, with a critical revision of the supporting evidences.