This editorial refers to ‘Complications leading to surgical revision in implantable cardioverter defibrillator patients: comparison of patients with single-chamber, dual chamber, and biventricular pacing’ by G.Z. Duray et al., on page 297 Implantable cardioverter defibrillators (ICDs) have become the standard of care for the prevention of sudden cardiac death and for the management of ventricular arrhythmias. In addition, the association of ICD with biventricular stimulation was demonstrated to improve quality of life and exercise capacity in patients with advanced New York Heart Association functional class, left ventricular ejection fraction ,0.35 and QRS duration .120 ms. These indications resulted in a 20-fold increase in annual device implants during the last 15 years, with a consequent rapid evolution of the device’s technology to answer to any different clinical situation (development of complex algorithm for pacing, for discrimination of arrhythmias, and for personalization of therapy). The same improvement of technology was applied to ICD leads and to left ventricular leads, trying to offer the best performance and the easiest technique of the implant. Nevertheless, several studies demonstrated that the ‘Achilles heel’ of the ICD system is the long-term reliability of the leads. Leads must survive to millions of cardiac cycles and allow high voltage energy delivery for defibrillation when necessary. It is understandable that with the increasing age of the leads, the risk of malfunction also increases. In fact, the reported incidence of malfunction rate of the leads reaches 40% after 8 years. 1–3 The most common abnormality reported by the studies is the insulation defect, which can result in a failure to detect and treat arrhythmias or in an inappropriate shock. This mainly affects patients’ safety, which depends on appropriate detection of potentially lethal ventricular arrhythmias and on successful delivery of therapy. A big help in this context comes from the wireless home monitoring of the device that can immediately detect any abnormality in the function of leads, thus reducing the risk for patients. Another point that could affect patients’ safety is the risk of re-intervention, which could increase the probability of system infection and introduce a not-trivial risk related to the extraction of previous leads.