Lead extraction is preferred for lead revisions and system upgrades: when less is more.

Cardiovascular implantable electronic device (CIED) use has increased exponentially during the past decade,1–3 with 4.5 million active devices and 1 million new leads implanted annually.4,5 With expanded CIED use and indications for device therapy, observed complications have increased in parallel.6–14 The occurrence of more frequent device system revisions for complications,6–8 system upgrades,15–17 and/or lead malfunction9–13 and longer patient life expectancies have mandated a paradigm shift toward premeditated lead management strategies from implant to removal or replacement. Consequently, clinicians increasingly are faced with the challenging choice of extraction or abandonment of sterile, superfluous leads. The decision is difficult and highly controversial,4,18–26 with limited rigorous evidence and passionate arguments on either side.