Renal Dysfunction Predicts Adverse Clinical Outcomes Independent of Arrhythmic Control After VT Ablation in Structural Heart Disease

Background The prognostic significance of renal dysfunction (RD) in patients undergoing catheter ablation for ventricular tachycardia (VT) in structural heart disease (SHD) remains incompletely defined. Whether RD reflects a marker of arrhythmia-independent disease severity or also compromises ablation efficacy is unknown. Objective To evaluate the association between RD and outcomes after VT ablation, focusing on whether RD affects arrhythmic efficacy (VT recurrence) independently of the composite endpoint of left ventricular assist device (LVAD) implantation, heart transplantation (HTx), or death. Methods We retrospectively analyzed 499 consecutive patients with SHD undergoing index VT ablation (2019–2025) at a tertiary center, stratified by RD status. The primary composite endpoint comprised LVAD, HTx, or death; VT recurrence was analyzed separately. Multivariable Cox regression assessed the independent association between RD and outcomes, adjusting for age, left ventricular ejection fraction (LVEF), sex, and cardiomyopathy etiology. Results Of 499 patients, 109 (21.8%) had RD. Patients with RD were older, had lower LVEF, and greater comorbidity burden (all p < 0.005). Procedural characteristics and VT recurrence were comparable between groups (47.7% vs. 47.9%, p = 1.00). The composite endpoint occurred more often with RD (48.6% vs. 21.3%, p < 0.001), with diverging event-free survival (log-rank p < 0.001). RD remained an independent predictor of the composite endpoint (HR 1.77, 95% CI 1.22–2.58, p = 0.003), consistent across LVAD (HR 1.79, p = 0.036), HTx (HR 2.22, p = 0.046), and death (HR 1.76, p = 0.022). Conclusion RD is associated with worse clinical outcomes after VT ablation despite preserved arrhythmic efficacy, and should be integrated into post-ablation risk stratification.