Transvenous lead extraction should be performed in the electrophysiology laboratory

Transvenous lead extraction (TLE) has evolved from a high-risk, last-resort procedure to a standardized therapy with expanding indications and improved safety. Although modern electrophysiology (EP) laboratories now rival hybrid operating rooms in capability, many institutions continue to perform TLE exclusively in operating rooms owing to outdated perceptions of risk, logistical barriers, and limited institutional support. This contributes to delays-particularly in infection-related cases-despite clear evidence that early extraction improves outcomes. Contemporary data confirm low rates of surgical complications, especially with advancements such as the vascular occlusion balloon, tandem technique, and ultrasound imaging. With appropriate safeguards, including surgical backup and emergency protocols, EP laboratories can safely accommodate TLE. Broader adoption of this model may enhance efficiency, expedite care, and better align TLE with other routine cardiovascular therapies. A deliberate, phased transition-supported by multidisciplinary collaboration and institutional readiness-is essential to modernizing TLE delivery in a familiar location.