Publications by authors named "Koh Kok Wei"

3 Publications

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Techniques for successful early retrieval of the Micra transcatheter pacing system: A worldwide experience.

Heart Rhythm 2018 06 8;15(6):841-846. Epub 2018 Feb 8.

Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address:

Background: Experience with retrieval of the Micra transcatheter pacing system (TPS) is limited because of its relatively newer technology. Although abandonment of the TPS at end of life is recommended, certain situations such as endovascular infection or device embolization warrant retrieval.

Objective: The purpose of this study was to report the worldwide experience with successful retrieval of the Micra TPS.

Methods: A list of all successful retrievals of the currently available leadless pacemakers (LPs) was obtained from the manufacturer of Micra TPS. Pertinent details of retrieval, such as indication, days postimplantation, equipment used, complications, and postretrieval management, were obtained from the database collected by the manufacturer. Other procedural details were obtained directly from the operators at each participating site.

Results: Data from the manufacturer consisted of 40 successful retrievals of the Micra TPS. Operators for 29 retrievals (73%) provided the consent and procedural details. Of the 29 retrievals, 11 patients underwent retrieval during the initial procedure (immediate retrieval); the other 18 patients underwent retrieval during a separate procedure (delayed retrieval). Median duration before delayed retrieval was 46 days (range 1-95 days). The most common reason for immediate retrieval was elevated pacing threshold after tether removal. The most common reasons for delayed retrieval included elevated pacing threshold at follow-up, endovascular infection, and need for transvenous device. Mean procedure duration was 63.11 ± 56 minutes. All retrievals involved snaring via a Micra TPS delivery catheter or steerable sheath. No serious complications occurred during the reported retrievals.

Conclusion: Early retrieval of the Micra TPS is feasible and safe.
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http://dx.doi.org/10.1016/j.hrthm.2018.02.008DOI Listing
June 2018

Treating an infected transcatheter pacemaker system via percutaneous extraction.

HeartRhythm Case Rep 2016 Jul 10;2(4):360-362. Epub 2016 May 10.

National Heart Institute, Kuala Lumpur, Malaysia.

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http://dx.doi.org/10.1016/j.hrcr.2016.04.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419892PMC
July 2016

A Comparison of Dabigatran With Warfarin for Stroke Prevention in Atrial Fibrillation in an Asian Population.

Clin Appl Thromb Hemost 2016 Nov 11;22(8):792-797. Epub 2015 May 11.

National Heart Institute, Kuala Lumpur, Malaysia.

Background: The Asian population with atrial fibrillation (AF) have a higher risk of stroke than the caucasian population and a higher risk of intracranial bleeding when anticoagulated with warfarin. There are few real-world studies comparing the efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin among Asian patients to assess its outcomes of ischemic stroke and hemorrhagic stroke.

Methods: A retrospective cohort study of 1000 patients on dabigatran and warfarin from 2009 to 2013.

Results: Data were available for 500 patients on dabigatran and 500 patients on warfarin. The average follow-up duration was 315 ± 280 days in the dabigatran group and 355 ± 232 in the warfarin group. The time in therapeutic range (TTR) was 53.2% in the warfarin-treated group, with 32.8% of patients in the subtherapeutic international normalized ratio range of <2. None of the patients in the dabigatran group had ischemic cerebrovascular accident (CVA) compared to 4 (0.8%) patients in the warfarin group, hazard ratio (HR) 0.13, P = .3. There was 1 (0.2%) patient in both dabigatran and warfarin groups with hemorrhagic CVA (HR 1.16, P = .92). There were 3 (0.6%) patients with major bleeding in the dabigatran group compared to 2 (0.4%) patients in the warfarin group (HR 1.57, P = .59).

Conclusion: There were similar rates of efficacy for outcomes of ischemic CVA, hemorrhagic CVA, and bleeding when comparing dabigatran with warfarin. Our study shows that despite similar efficacy, suboptimal TTR rates and inconveniences with warfarin demonstrate that NOACs are preferred for stroke prevention in AF.
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http://dx.doi.org/10.1177/1076029615584664DOI Listing
November 2016