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Lead removal is removal of a pacing or defibrillator lead using any technique. It includes two completely different procedures: lead explant and lead extraction. Lead explant is the removal of a lead using simple traction techniques, which is usually possible for leads implanted for less than 1 year. Lead extraction is removal of a lead implanted for more than 1 year or that requires the assistance of specialized equipment in order to be removed. Lead extraction is by far the more complex procedure. As it carries some risks for the patient, clear indications, expertly trained personnel, adequate tools, and appropriate environment and facilities are mandatory for its safe removal [1], [2].

Internal cardioverter defibrillator (ICD) therapy has come a long way since its introduction in the 1980s as the first-line treatment for the few fortunate survivors of recurrent sudden cardiac arrest (SCA). Secondary- and primary-prevention trials enrolling patients with either ischemic or nonischemic cardiomyopathy with depressed left ventricular ejection fraction (LVEF) and NYHA II–IV (AVID, CIDS, CASH, MADIT, MUSTT, MADIT II, DEFINITE) have overwhelmingly demonstrated that ICD therapy reduces total mortality compared with anti-arrhythmic drug therapy and/or optimal medical therapy [1, 2, 3, 4, 5, 6, 7]. The most recent trials (COMPANION and SCD-HeFT) [8, 9] focused on patients with NYHA class II–IV heart-failure (HF) symptoms and depressed LVEF: ICD alone or combined with a left ventricular lead for cardiac resynchronization significantly reduced total mortality as compared with optimal medical therapy (ACE inhibitors/ARB blockers, beta-blockers, canrenoate, diuretics) and amiodarone.