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Donald Dale Hegland

Associate Professor of Medicine
Medicine, Cardiology
Duke Box 3174, Durham, NC 27710
Erwin Road, Duke North Hospital, Durham, NC 27710

Selected Publications


Lead Extraction and Mortality Among Patients With Cardiac Implanted Electronic Device Infection.

Journal Article JAMA Cardiol · December 1, 2023 IMPORTANCE: Complete hardware removal is a class I recommendation for cardiovascular implantable electronic device (CIED) infection, but practice patterns and outcomes remain unknown. OBJECTIVE: To quantify the number of Medicare patients with CIED infecti ... Full text Link to item Cite

Efficacy and Safety of Adjunctive and Primary Use of the TightRail Mechanical Cutting Sheath for Lead Extraction.

Journal Article Circ Arrhythm Electrophysiol · June 2023 BACKGROUND: Rotational cutting tools are increasingly used in transvenous lead extraction. There are limited data on their safety and efficacy, particularly when used adjunctively for stalled progression. The aim of this study was to evaluate the utilizati ... Full text Link to item Cite

Leadless pacemaker implantation after lead extraction for cardiac implanted electronic device infection.

Journal Article J Cardiovasc Electrophysiol · March 2022 BACKGROUND: Cardiac implanted electronic device (CIED) pocket and systemic infection remain common complications with traditional CIEDs and are associated with high morbidity and mortality. Leadless pacemakers may be an attractive pacing alternative for ma ... Full text Link to item Cite

Cases of Azygous Coil Extraction.

Journal Article Heart Rhythm O2 · February 2022 BACKGROUND: Procedural and clinical outcomes of patients undergoing extraction or removal of azygous coils are not well characterized. OBJECTIVE: Evaluate outcomes in patients who undergo device extraction with an azygous coil in situ. METHODS: Patients un ... Full text Link to item Cite

Optimizing mechanically sensed atrial tracking in patients with atrioventricular-synchronous leadless pacemakers: A single-center experience.

Journal Article Heart Rhythm O2 · October 2021 BACKGROUND: Atrioventricular (AV)-synchronous single-chamber leadless pacing using a mechanical atrial sensing algorithm produced high AV synchrony in clinical trials, but clinical practice experience with these devices has not yet been described. OBJECTIV ... Full text Open Access Link to item Cite

Catheter ablation of atrial fibrillation in cardiac amyloidosis.

Journal Article Pacing Clin Electrophysiol · September 2020 BACKGROUND: Cardiac amyloidosis is a progressive infiltrative disease involving deposition of amyloid fibrils in the myocardium and cardiac conduction system that frequently manifests with heart failure (HF) and arrhythmias, most frequently atrial fibrilla ... Full text Link to item Cite

Cardiovascular Implantable Electronic Device Surgery Following Left Ventricular Assist Device Implantation.

Journal Article JACC Clin Electrophysiol · September 2020 OBJECTIVES: This study sought to determine the indications, characteristics, and outcomes of cardiovascular implantable electronic device (CIED) surgery in patients with LVAD. BACKGROUND: Many patients with a left ventricular assist device (LVAD) will requ ... Full text Link to item Cite

Catheter ablation of atrial fibrillation in patients with diabetes mellitus.

Journal Article Heart Rhythm O2 · August 2020 BACKGROUND: Diabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). Few studies have compared clinical outcomes after catheter ablation between patients with and those without DM. OBJECTIVE: The purpose of this study was to compa ... Full text Open Access Link to item Cite

Hands on: How to approach patients undergoing lead extraction.

Journal Article J Cardiovasc Electrophysiol · July 2020 Due to the growing number of patients treated with cardiac implantable electronic devices (CIEDs) there is an increased need for lead management, evaluation, and extraction. While CIED lead extraction has many indications, a consistent approach to preproce ... Full text Link to item Cite

Lead Extraction for Cardiovascular Implantable Electronic Device Infection in Patients With Left Ventricular Assist Devices.

Journal Article JACC Clin Electrophysiol · June 2020 OBJECTIVES: The goal of this study was to assess the utility of transvenous lead extraction for cardiovascular implantable electronic device (CIED) infection in patients with a left ventricular assist device (LVAD). BACKGROUND: The use of transvenous lead ... Full text Link to item Cite

Preprocedural computed tomography before cardiac implanted electronic device lead extraction: Indication, technique, and approach to interpretation.

Journal Article J Cardiovasc Electrophysiol · March 2020 Cardiac implantable electronic devices (CIEDs) frequently need to be extracted due to infection, hardware failure, and other causes. The extraction of the CIED is typically performed using percutaneous methods. While these procedures are mostly performed w ... Full text Link to item Cite

Safety and efficacy outcomes of left atrial posterior wall isolation compared to pulmonary vein isolation and pulmonary vein isolation with linear ablation for the treatment of persistent atrial fibrillation.

Journal Article Am Heart J · February 2020 BACKGROUND: Pulmonary wall isolation (PWI) is increasingly used as an adjunctive lesion set to compliment pulmonary vein isolation (PVI), especially in patients with persistent atrial fibrillation (AF). The objective was to compare outcomes of catheter abl ... Full text Link to item Cite

Effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology.

Journal Article J Arrhythm · February 2020 BACKGROUND: Catheter ablation is an important rhythm control therapy in patients with atrial fibrillation (AF) with concomitant heart failure (HF). The objective of this study was to assess the comparative efficacy of AF ablation patients with ischemic vs ... Full text Open Access Link to item Cite

Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP-AF risk scoring systems.

Journal Article Pacing Clin Electrophysiol · November 2019 BACKGROUND: Compared with medical therapy, catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) improves cardiovascular outcomes. Risk scores (CAAP-AF and APPLE) have been developed to predict the likelihood of AF recurrence af ... Full text Open Access Link to item Cite

Multimodal imaging for cardiac mapping

Chapter · April 5, 2019 Mapping and elimination (ablation) of an abnormal cardiac rhythm requires an understanding of normal and abnormal anatomy and physiology, and monitoring of the interventional catheters and ablation energy’s effects. Cardiac electrophysiology has evolved en ... Full text Cite

Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction.

Journal Article Heart Rhythm · May 2018 BACKGROUND: Few studies have examined outcomes of catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) with preserved ejection fraction (HFpEF). OBJECTIVE: The purpose of this study was to compare outcomes of AF ablation in pa ... Full text Link to item Cite

Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads.

Journal Article Circulation · October 10, 2017 BACKGROUND: Lead management is an increasingly important aspect of care in patients with cardiac implantable electronic devices; however, relatively little is known about long-term outcomes after capping and abandoning leads. METHODS: Using the 5% Medicare ... Full text Link to item Cite

Temporal Trends in and Factors Associated With Use of Single- Versus Dual-Coil Implantable Cardioverter-Defibrillator Leads: Data From the NCDR ICD Registry.

Journal Article JACC Clin Electrophysiol · June 2017 OBJECTIVES: This analysis evaluated temporal trends and factors associated with the use of dual-coil implantable cardioverter-defibrillator (ICD) leads. BACKGROUND: Data suggest that dual-coil ICD leads are not associated with lower mortality and can be mo ... Full text Link to item Cite

Lead Extraction and Mortality Among Patients With Cardiac Implanted Electronic Device Infection.

Journal Article JAMA Cardiol · December 1, 2023 IMPORTANCE: Complete hardware removal is a class I recommendation for cardiovascular implantable electronic device (CIED) infection, but practice patterns and outcomes remain unknown. OBJECTIVE: To quantify the number of Medicare patients with CIED infecti ... Full text Link to item Cite

Efficacy and Safety of Adjunctive and Primary Use of the TightRail Mechanical Cutting Sheath for Lead Extraction.

Journal Article Circ Arrhythm Electrophysiol · June 2023 BACKGROUND: Rotational cutting tools are increasingly used in transvenous lead extraction. There are limited data on their safety and efficacy, particularly when used adjunctively for stalled progression. The aim of this study was to evaluate the utilizati ... Full text Link to item Cite

Leadless pacemaker implantation after lead extraction for cardiac implanted electronic device infection.

Journal Article J Cardiovasc Electrophysiol · March 2022 BACKGROUND: Cardiac implanted electronic device (CIED) pocket and systemic infection remain common complications with traditional CIEDs and are associated with high morbidity and mortality. Leadless pacemakers may be an attractive pacing alternative for ma ... Full text Link to item Cite

Cases of Azygous Coil Extraction.

Journal Article Heart Rhythm O2 · February 2022 BACKGROUND: Procedural and clinical outcomes of patients undergoing extraction or removal of azygous coils are not well characterized. OBJECTIVE: Evaluate outcomes in patients who undergo device extraction with an azygous coil in situ. METHODS: Patients un ... Full text Link to item Cite

Optimizing mechanically sensed atrial tracking in patients with atrioventricular-synchronous leadless pacemakers: A single-center experience.

Journal Article Heart Rhythm O2 · October 2021 BACKGROUND: Atrioventricular (AV)-synchronous single-chamber leadless pacing using a mechanical atrial sensing algorithm produced high AV synchrony in clinical trials, but clinical practice experience with these devices has not yet been described. OBJECTIV ... Full text Open Access Link to item Cite

Catheter ablation of atrial fibrillation in cardiac amyloidosis.

Journal Article Pacing Clin Electrophysiol · September 2020 BACKGROUND: Cardiac amyloidosis is a progressive infiltrative disease involving deposition of amyloid fibrils in the myocardium and cardiac conduction system that frequently manifests with heart failure (HF) and arrhythmias, most frequently atrial fibrilla ... Full text Link to item Cite

Cardiovascular Implantable Electronic Device Surgery Following Left Ventricular Assist Device Implantation.

Journal Article JACC Clin Electrophysiol · September 2020 OBJECTIVES: This study sought to determine the indications, characteristics, and outcomes of cardiovascular implantable electronic device (CIED) surgery in patients with LVAD. BACKGROUND: Many patients with a left ventricular assist device (LVAD) will requ ... Full text Link to item Cite

Catheter ablation of atrial fibrillation in patients with diabetes mellitus.

Journal Article Heart Rhythm O2 · August 2020 BACKGROUND: Diabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). Few studies have compared clinical outcomes after catheter ablation between patients with and those without DM. OBJECTIVE: The purpose of this study was to compa ... Full text Open Access Link to item Cite

Hands on: How to approach patients undergoing lead extraction.

Journal Article J Cardiovasc Electrophysiol · July 2020 Due to the growing number of patients treated with cardiac implantable electronic devices (CIEDs) there is an increased need for lead management, evaluation, and extraction. While CIED lead extraction has many indications, a consistent approach to preproce ... Full text Link to item Cite

Lead Extraction for Cardiovascular Implantable Electronic Device Infection in Patients With Left Ventricular Assist Devices.

Journal Article JACC Clin Electrophysiol · June 2020 OBJECTIVES: The goal of this study was to assess the utility of transvenous lead extraction for cardiovascular implantable electronic device (CIED) infection in patients with a left ventricular assist device (LVAD). BACKGROUND: The use of transvenous lead ... Full text Link to item Cite

Preprocedural computed tomography before cardiac implanted electronic device lead extraction: Indication, technique, and approach to interpretation.

Journal Article J Cardiovasc Electrophysiol · March 2020 Cardiac implantable electronic devices (CIEDs) frequently need to be extracted due to infection, hardware failure, and other causes. The extraction of the CIED is typically performed using percutaneous methods. While these procedures are mostly performed w ... Full text Link to item Cite

Safety and efficacy outcomes of left atrial posterior wall isolation compared to pulmonary vein isolation and pulmonary vein isolation with linear ablation for the treatment of persistent atrial fibrillation.

Journal Article Am Heart J · February 2020 BACKGROUND: Pulmonary wall isolation (PWI) is increasingly used as an adjunctive lesion set to compliment pulmonary vein isolation (PVI), especially in patients with persistent atrial fibrillation (AF). The objective was to compare outcomes of catheter abl ... Full text Link to item Cite

Effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology.

Journal Article J Arrhythm · February 2020 BACKGROUND: Catheter ablation is an important rhythm control therapy in patients with atrial fibrillation (AF) with concomitant heart failure (HF). The objective of this study was to assess the comparative efficacy of AF ablation patients with ischemic vs ... Full text Open Access Link to item Cite

Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP-AF risk scoring systems.

Journal Article Pacing Clin Electrophysiol · November 2019 BACKGROUND: Compared with medical therapy, catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) improves cardiovascular outcomes. Risk scores (CAAP-AF and APPLE) have been developed to predict the likelihood of AF recurrence af ... Full text Open Access Link to item Cite

Multimodal imaging for cardiac mapping

Chapter · April 5, 2019 Mapping and elimination (ablation) of an abnormal cardiac rhythm requires an understanding of normal and abnormal anatomy and physiology, and monitoring of the interventional catheters and ablation energy’s effects. Cardiac electrophysiology has evolved en ... Full text Cite

Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction.

Journal Article Heart Rhythm · May 2018 BACKGROUND: Few studies have examined outcomes of catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) with preserved ejection fraction (HFpEF). OBJECTIVE: The purpose of this study was to compare outcomes of AF ablation in pa ... Full text Link to item Cite

Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads.

Journal Article Circulation · October 10, 2017 BACKGROUND: Lead management is an increasingly important aspect of care in patients with cardiac implantable electronic devices; however, relatively little is known about long-term outcomes after capping and abandoning leads. METHODS: Using the 5% Medicare ... Full text Link to item Cite

Temporal Trends in and Factors Associated With Use of Single- Versus Dual-Coil Implantable Cardioverter-Defibrillator Leads: Data From the NCDR ICD Registry.

Journal Article JACC Clin Electrophysiol · June 2017 OBJECTIVES: This analysis evaluated temporal trends and factors associated with the use of dual-coil implantable cardioverter-defibrillator (ICD) leads. BACKGROUND: Data suggest that dual-coil ICD leads are not associated with lower mortality and can be mo ... Full text Link to item Cite

An Automated Surveillance Strategy to Identify Infectious Complications After Cardiac Implantable Electronic Device Procedures.

Journal Article Open Forum Infect Dis · December 2015 Background.  The optimum approach for infectious complication surveillance for cardiac implantable electronic device (CIED) procedures is unclear. We created an automated surveillance tool for infectious complications after CIED procedures. Methods.  Adult ... Full text Open Access Link to item Cite

Clinical outcome as a function of the PR-interval-there is virtue in moderation: data from the Duke Databank for cardiovascular disease.

Journal Article Europace · June 2015 AIMS: Recently, a U-shaped association between PR-interval and the risk of developing atrial fibrillation was described, with higher risk in patients with long and short PR-intervals. Little is known regarding the association of PR-interval duration and mo ... Full text Link to item Cite

Cardiac implantable electronic device removal in patients with left ventricular assist device associated infections.

Journal Article J Cardiovasc Electrophysiol · November 2014 INTRODUCTION: Heart failure patients with left ventricular assist devices (LVADs) are at risk for infection. Cardiac implantable electronic devices (CIEDs) are commonly present in these patients. The course of infections in patients with an LVAD and a CIED ... Full text Link to item Cite

Preprocedural ECG-gated computed tomography for prevention of complications during lead extraction.

Journal Article Pacing Clin Electrophysiol · October 2014 BACKGROUND: Preprocedural multidetector computed tomography (MDCT) may identify patients at risk for mechanical complications during lead extraction. METHODS: To describe the use and feasibility of computed tomography scanning for preprocedural planning of ... Full text Link to item Cite

Comparative effectiveness of pharmacotherapies for prevention of atrial fibrillation following coronary artery bypass surgery.

Journal Article The American journal of cardiology · October 2013 Risk of atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is high, yet the effectiveness of guideline-recommended preoperative prophylaxis in clinical practice remains uncertain. We determined the utilization and variation of preoperati ... Full text Cite

Follow-up of patients with new cardiovascular implantable electronic devices: is adherence to the experts' recommendations associated with improved outcomes?

Journal Article Heart Rhythm · August 2013 BACKGROUND: A 2008 expert consensus statement recommended an in-person follow-up visit between 2 and 12 weeks after the placement of a new cardiovascular implantable electronic device (CIED). OBJECTIVE: To assess outcomes associated with adherence to the e ... Full text Link to item Cite

Impact of using a telescoping-support catheter system for left ventricular lead placement on implant success and procedure time of cardiac resynchronization therapy.

Journal Article Pacing Clin Electrophysiol · May 2013 BACKGROUND: Proper positioning of the left ventricular (LV) lead improves clinical outcomes and survival in patients receiving cardiac resynchronization therapy (CRT). Techniques of LV lead insertion using contrast injection and a telescoping system of del ... Full text Link to item Cite

Assessment of myocardial scarring improves risk stratification in patients evaluated for cardiac defibrillator implantation.

Journal Article J Am Coll Cardiol · July 31, 2012 OBJECTIVES: We tested whether an assessment of myocardial scarring by cardiac magnetic resonance imaging (MRI) would improve risk stratification in patients evaluated for implantable cardioverter-defibrillator (ICD) implantation. BACKGROUND: Current sudden ... Full text Link to item Cite

Pulmonary vein contraction before and after radiofrequency ablation for atrial fibrillation.

Journal Article J Cardiovasc Electrophysiol · February 2011 UNLABELLED:   INTRODUCTION: Cardiovascular magnetic resonance imaging (cMRI) may provide a noninvasive method to test for pulmonary vein (PV) isolation after ablation for atrial fibrillation (AF) by detecting changes in PV contraction. METHODS: PV contract ... Full text Link to item Cite

Clinical problem-solving. A hole in the argument.

Journal Article N Engl J Med · December 1, 2005 Full text Link to item Cite

Regulation of endothelial cell adherens junctions by a Ras-dependent signal transduction pathway.

Journal Article Biochem Biophys Res Commun · July 5, 1999 Adherens junctions, consisting of transmembrane cadherin molecules and their associated cytoplasmic alpha-, beta-, and gamma-catenin proteins, are thought to be critical for the development of stable cell adhesion and subsequent 3-dimensional tissue organi ... Full text Link to item Cite

VEGF stimulates MAPK through a pathway that is unique for receptor tyrosine kinases.

Journal Article Biochem Biophys Res Commun · February 16, 1999 We demonstrate that stimulation of primary cultures of endothelial cells with vascular endothelial cell growth factor (VEGF) results in a rapid increase in labeled guanine nucleotide bound to p21ras. Surprisingly, although VEGF stimulates ras activity, ade ... Full text Link to item Cite

A requirement for the rac1 GTPase in the signal transduction pathway leading to cardiac myocyte hypertrophy.

Journal Article J Clin Invest · September 1, 1998 We have used adenoviral-mediated gene transfer of a constitutively active (V12rac1) and dominant negative (N17rac1) isoform of rac1 to assess the role of this small GTPase in cardiac myocyte hypertrophy. Expression of V12rac1 in neonatal cardiac myocytes r ... Full text Link to item Cite

Effect of a dominant negative ras on myocardial hypertrophy by using adenoviral-mediated gene transfer.

Journal Article Surgery · August 1997 BACKGROUND: The small guanosine triphosphate-binding protein ras regulates a signal transduction cascade linking cell surface receptors to mitogen-activated protein kinase (MAPK). Because the molecular signaling mechanisms underlying cardiac hypertrophy re ... Full text Link to item Cite