Impact of chronic kidney disease on short- and long-term outcomes after ventricular tachycardia ablation

Background Chronic kidney disease (CKD) is a commonly coexisting condition in patients undergoing ventricular tachycardia (VT) ablation. Patients with CKD are often under-represented in clinical trials and therefore, there is limited data on clinical outcomes after VT ablation in these patients. We sought to evaluate the association between CKD and post-procedural outcomes in patients undergoing VT ablation using a large, real-world, multicenter dataset. Methods We identified a total of 6,849 patients who underwent VT ablation during the time-period of 01/2025 to 12/2021 from the TriNetX research network dataset. For the purpose of our analyses, we stratified patients into two cohorts: those with CKD and those without CKD. Propensity score matching (1:1) was performed to balance demographics, comorbidities, and medications, resulting in 1,689 matched patients in each subgroup. Follow-up data on clinical outcomes for up to 3 years after the index VT ablation was available. Short-term outcomes (0–30 days post-ablation) included acute kidney injury (AKI), critical care utilization and mechanical circulatory support use, while long-term outcomes (30 days–3 years) included all-cause mortality, cardiac transplant and ischemic stroke. Kaplan-Meier analysis and Cox proportional hazards models were used to estimate hazard ratios (HRs) for the comparison of these clinical outcomes. Results In the short term (< 30 days) after VT ablation, patients with CKD had a higher rate of acute kidney injury (14.6% vs. 4.1%; HR 3.76, 95% CI 2.88–4.91; p<0.0001), utilization of mechanical support (7.1% vs. 3.7%; HR 1.95, 95% CI 1.44–2.65; p<0.0001), and critical care utilization (19.8% vs. 12.7%; HR 1.61, 95% CI 1.35–1.91; p<0.0001). Over long-term follow-up (>30 days–3 years), CKD was associated with higher all-cause mortality (HR 1.84, 95% CI 1.51–2.23), cardiac transplant (HR 4.51, 95% CI 2.74–7.43) and ischemic stroke (HR 1.44, 95% CI 1.09–1.90). All comparisons were statistically significant, with p < 0.05. Conclusions In patients undergoing VT ablation, CKD was independently associated with higher risk of AKI, ischemic mortality, need for cardiac transplantation and all-cause mortality. These findings underscore the importance of incorporating CKD as an independent risk factor to improve risk-stratification in patients undergoing VT ablation.