Peri-Procedural Ischemic Stroke in Patients Undergoing Ventricular Tachycardia Ablation: Incidence, Predictors, and Impact on Mortality.

BACKGROUND: Ventricular tachycardia (VT) ablation is an established treatment for recurrent VT; however, the prognostic significance of peri-procedural ischemic stroke (P-IS) in this population remains poorly characterized. OBJECTIVE: This study examined the incidence, predictors, and mortality impact of P-IS among patients undergoing VT ablation using a large nationwide database. METHODS: The Nationwide Readmission Database (NRD) 2016-2021 was queried to identify patients undergoing VT ablation. ICD-10-CM and ICD-10-PCS codes were used to define the study cohort. P-IS was defined as an ischemic stroke occurring during the index hospitalization. Predictors of P-IS and its associated mortality were subsequently analyzed. RESULTS: Of 57,624 patients who underwent VT ablation, 1,758 (3.05%) experienced P-IS. Compared to patients without stroke, those with P-IS were older and carried a significantly higher comorbidity burden (Elixhauser index >6: 50.5% vs. 32.7%, p<0.001). Peri-procedural stroke was associated with a threefold increase in in-hospital mortality. ICU admission (OR 8.76, 95% CI 5.07-15.13, p<0.001), cardiogenic shock (OR 2.25, 95% CI 1.22-4.16, p=0.009), and pulmonary embolism (OR 16.25, 95% CI 1.23-214.56, p=0.034) were independently associated with increased mortality following stroke. CONCLUSION: In this large real-world cohort, P-IS following VT ablation occurred in approximately 3% of patients and was associated with a marked increase in in-hospital mortality. Risk was further amplified by cardiovascular comorbidities and indicators of critical illness. These findings underscore the need for dedicated studies evaluating strategies to mitigate P-IS risk in patients undergoing VT ablation.