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The study by Selton-Suty published in Heart describes the performance of three different diagnostic criteria for cardiac implantable electronic device (CIED) infective endocarditis (IE) in relation to the diagnostic classification of an expert adjudication panel.1 The study is very carefully performed by a team with expertise in this field. The subject is indeed important to study since the patients affected have significant morbidity and mortality. A diagnosis of definite CIED infection has consequences for the patients (device extraction), and we, as clinicians, are notoriously challenged in diagnosing the condition. Echocardiography is the main diagnostic tool, but it is challenging as studies have shown that as much as 15% of non-infected pacemaker leads have thrombi/masses that may mimic vegetations potentially leading to overdiagnosis.2 Moreover, only a part of the lead is well visualised during echocardiography, risking underdiagnosis. Hence, we complement the authors for, despite these challenges, trying to improve the diagnostic criteria and the understanding of CIED infection. Ultimately, however, better biomarkers for CIED infection and better diagnostic tools will be needed for improved diagnosis and treatment of CIED-IE.