Risk Factors for Bleeding Following Combined Catheter Ablation and Left Atrial Appendage Occlusion in Patients With...

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• Patients with nonvalvular atrial fibrillation (NVAF) undergoing combined catheter ablation (CA) and left atrial appendage occlusion (LAAO) may experience bleeding events despite low HAS-BLED scores (≤2).
• Conventional bleeding risk scores may not adequately identify individuals at risk in this specific population.

Purpose of the Study:

• To identify factors associated with post-procedural bleeding in NVAF patients with low HAS-BLED scores undergoing combined CA and LAAO.
• To explore predictors of bleeding events in a carefully selected cohort undergoing complex cardiac procedures.

Main Methods:

• Retrospective analysis of 209 NVAF patients with HAS-BLED ≤2 who underwent first-time CA and LAAO.
• Exclusion of patients with active bleeding or severe hepatic/renal impairment (eGFR <30 mL/min/1.73 m²).
• Multivariable Firth's penalized-likelihood regression used due to a limited number of bleeding events (n=10) to mitigate small-sample bias.

Main Results:

• Ten patients (4.78%) experienced Bleeding Academic Research Consortium (BARC)-defined bleeding events over a mean 30-month follow-up.
• Independent predictors of bleeding included advanced age (aOR 1.13 per year), history of myocardial infarction (MI) (aOR 36.82), and renal insufficiency (eGFR <60 mL/min/1.73 m²) (aOR 21.16).
• Model performance showed an optimism-corrected c-statistic of 0.82, but effect estimates, especially for MI, have limited precision due to the small event count.

Conclusions:

• Renal insufficiency, history of MI, and advanced age are associated with bleeding events in NVAF patients with low HAS-BLED scores undergoing combined CA and LAAO.
• These findings suggest that current risk stratification tools may be insufficient for this patient group.
• Further validation in larger, prospective multicenter studies is necessary before clinical application of these identified risk factors.