A lead implantation tool is used for the implantation of active fixation medical leads. The tool may be configured to operably couple to a lead connector end of an implantable cardiac electrotherapy lead including an active fixation helix tip and wherein the lead connector end includes a contact pin proximally extending from the lead connector end. The tool may include a feature configured to couple to the contact pin and a first mechanism configured to convert linear movement into rotational movement of the contact pin relative to the lead connector end. The tool may further include a second mechanism that causes a stylet extending through the tool and into the contact pin to at least one of distally and proximally displace within the contact pin.