With the increasing numbers of cardiac implantable devices in use, lead extraction has become a critical procedure in remedying device-related infections and complications. Lead extraction technology has grown considerably over the past two decades from simple traction maneuvers to the use of powered, telescoping sheaths equipped with laser technology. Data from single center experiences and randomized control trials have continued to demonstrate the safety and efficacy of the most current lead extraction technology. Still, major complications occur in less than 1% of patients. Patient preparation and in-place laboratory protocols are important for the prevention of complications and the rapid diagnosis and treatment of life-threatening complications should they arise.