In this interview, Dr Charles Henrikson, electrophysiologist and head of the electrophysiology section at Oregon Health & Science University, discusses key considerations and emerging challenges in lead extraction and cardiac ablation. He explains that lead extraction procedures must be highly individualized, taking into account factors such as patient age, lead age, comorbidities, and the strength of the clinical indication—particularly in cases of device infection where complete extraction is often necessary. Dr. Henrikson also highlights growing interest in pulse field ablation, noting that while the technology has expanded rapidly, more research is needed to better understand its potential interactions with pacemakers and defibrillators. In addition, he shares insights from a novel case presented at the meeting involving ventricular tachycardia originating near a defibrillator lead tip, where physicians successfully ablated through the lead before extracting and replacing it, demonstrating an innovative approach to a highly complex clinical challenge.