Background: As per the United Nations World Population prospectus, the life expectancy in the USA is 79.4 yrs. Even among the elderly geriatric population, the nonagenarians and centenarians are a rapidly growing subgroup. These patients are typically excluded from large clinical trials involving the placement of pacemaker or ICD devices. Because of the advanced age factor, both the patient and physicians may be dissuaded from considering device implantation, even though indicated; thus preventing the patients from receiving therapies that may be beneficial. We aim to study the safety and efficacy of the implantation of pacemakers and/or ICDʼs in geriatric patients above the age of 90 yearsMethods: Since January 2008, clinical and outcome data of pts > 90 yrs age undergoing new PPM/ICD implantation or generator change/upgrade were prospectively collected. Patients were closely followed at regular intervals.Results: There were 51 patients with a mean current age of 96.7 and a mean age of 93.4 years at the time of device implantation in our study. There were 36 (71%) females in our study. 47 patients (92%) underwent new device implantation: 43 PPMs and 4 ICDS. The remainder 4 patients (8%) underwent PPM generator change. Among the patients who received new device implantation, only one developed pneumothorax. No patients undergoing generator change had temporary lead insertion during the procedure. For ICD indication, active fixation leads were used in all patients. Defibrillation thresholds were not performed. At regular follow-ups over 3 years, 48 patients are alive, and 14 patients are >100 years of age. All devices are functioning well. One patient with new ICD implantation had successful arrhythmia termination by antitachycardia pacing within 1 yr of implantation.Conclusion: Cautious implantation of PPMs and ICDs and their generator change outs are safe and effective in the geriatric population, including the nonagenarians and the centenarians.