Comparison of Rate Control Agents in Patients Referred for Left Atrial Appendage Closure

Abstract 2300409, presented at Western Atrial Fibrillation Symposium 2026

Direct oral anticoagulants (DOACs) have emerged as preferred agents in managing atrial fibrillation (AF) due to their superior prevention of stroke and major bleeding compared to warfarin. Recently, the combination of factor Xa inhibitors with non-dihydropyridine calcium channel blockers (non-DHP CCBs) has revealed increased bleeding rates compared to other methods of rate control. This study aims to investigate the prevalence of being on CCBs and DOACs with referrals for bleeding events in patients with AF who underwent left atrial appendage occlusion (LAAO).This retrospective single center study included 409 patients who underwent LAAO from August 2020 to October 2023. Chi-Squared and multivariable logistical regression analysis were used to test for association between the DOAC and non-DHP CCB combination with bleeding events. Other variables of interest were vitamin K antagonist use, amiodarone use, age, sex, heart failure, hypertension, cerebrovascular accidents, vascular disease, diabetes mellitus, weight, aspirin use, P2Y12 inhibitor use, sleep apnea, and left ventricular ejection fraction.Of the 409 participants, 211 (52%) were referred for bleeding events, and 198 (48%) were referred for non-bleeding events. Patient characteristics included a mean age of 74.5±7.8 years, 187 (45.7%) females, and median CHA2DS2-VASc score of 5. Of the 211 patients with bleeding events, 55 (26.1%) were on the combination of non-DHP CCBs and DOACs. In the non-bleeding group, 16 (8.1%) patients were on this drug combination. Multivariable analysis revealed that the use of non-DHP CCBs and DOACs was the strongest predicting factor of bleeding events (OR 2.17, CI 1.29-3.17, p=0.004). While a significant positive correlation with referral for bleeding was present in patients with vascular disease (p=0.009), negative correlations with bleeding referral were found in patients with VKA use (p=0.02), and hypertension (p=0.028). Chi-Squared analysis showed a significant correlation between DOAC and non-DHP CCB combination with bleeding events (p< 0.001).Our observational data suggests a significant association between CCB and DOAC combination and bleeding related referral for LAAO. In working up patients for invasive management, medical optimization should be considered. Given the limited sample size, further investigation is required.