The rate of implantation of pacemakers and implantable cardioverter-defibrillators (ICDs) is ever-increasing. The relative ease of device implantation utilizing a relatively simple, expeditious, percutaneous approach, without the requirement for general anesthesia or long recuperation times, has fueled enthusiasm for implantation. However, the complication risk is ever-present and forms the subject of this pragmatic review, which is limited to the management of only the surgical complications of device implantation. The management of surgical complications related to the implantation of pacemakers and ICDs should include (1) awareness of potential complications, (2) a meticulous approach to the implantation procedure to avoid complications, (3) approach to diagnosis and (4) specific therapy. With a clear understanding of the accepted implant indications and potential complications, and a meticulous approach to the implant and post implant follow up, the incidence of complications can be minimized.