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In developing countries, patients with a cardiac rhythm management device (CRMD) that has become infected cannot always afford a new device, and reuse of the infected CRMD may be appropriate. To evaluate the safety of this practice, a cohort of consecutive patients with reused pacemakers was compared with a control group.A single-center cohort of consecutive patients treated from 2007 to 2012 was analyzed in a two-way noninferiority study. Patients who had infected CRMDs removed at the Cardiovascular Center of The Peking University People's Hospital were enrolled, including those who had the same CRMD reimplanted and those who had a new CRMD implanted.This study included 212 patients, of who 99 (study group) had the same CRMD reimplanted, and 113 (control group) had a new CRMD implanted. During a mean follow-up period of 3.52 years (interquartile range: 2.1–4.7 years), 10 patients reached the primary end point of the study (infection, unexpected battery depletion, or device malfunction), including five (5%) in the study group and five (4.3%) in the control group. Recurrent infection occurred in three patients in the study group and two patients in the control group (3.0% vs 1.7%, relative risk: 1.29, 95% confidence interval: 0.62–2.29, P = 0.561). There were no cases of unexpected battery depletion in either group.Reuse of infected CRMDs in the same patients is noninferior to the implantation of new devices. In developing countries without full medical coverage, careful reuse of infected CRMDs can be considered.