Purpose <p>Laser lead extraction has been previously associated with higher rates of complications and increased mortality. We sought to determine the safety and efficacy of laser lead extraction of CIED leads in isolate and when compared to other extraction modalities.</p> Methods <p>We retrospectively reviewed all CIED lead extractions between June 2013 and December 2023. Outcomes included success rates, complication rates, and 90-day mortality. Analyses were multivariate, and laser lead extraction was compared against all extraction modalities and against exclusively transvenous extractions.</p> Results <p>Among 686 extractions, 499 (73%) underwent laser lead extraction of all leads requiring treatment which was associated with high rates of completely successful extractions (95.8%) and low major complication rates (1.6%). In our cohort, the primary determinant of 90-day mortality was the presence of systemic infection. After exclusion of systemic infections, laser lead extractions exhibited low rates of 90-day mortality (1.5%). While direct comparisons are impeded by our study design, laser lead extraction of all leads requiring treatment was correlated with higher success rates (95.8% vs. 90.6%, <i>p</i> = 0.01), similar major complication rates (1.6% vs. 1.2%, <i>p</i> = 0.88), and no significant difference in 90-day mortality among noninfected patients (HR 0.42, <i>p</i> = 0.22) when compared alongside other extraction modalities.</p> Conclusion <p>Laser lead extraction of CIED leads was safe and effective, as evidenced by high success rates, low complication rates, and low 90-day mortality.</p>