The need for lead extraction has increased exponentially in the last decade due to greatly increased “total lead exposure time.” The increased total lead exposure time is the result of new indications for device treatment, device therapy involving more leads per patient, and longer average patient life. Improved general lead reliability noted over recent years may have decreased slightly the need for extraction; however, this effect is more than countered by recent advisories, recalls, and increased complication rates, probably related to many new centers offering device treatment.