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 2016-2021 was queried to identify patients undergoing VT ablation. International Classification of Diseases, Tenth Revision, Clinical Modification and International Classification of Diseases, 10th Revision, Procedure Coding System 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 the 57,624 patients who underwent VT ablation, 1758 (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 < .001). Peri-procedural stroke was associated with a 3-fold increase in in-hospital mortality. Intensive care unit admission (OR, 8.76; 95% CI, 5.07-15.13; P < .001), cardiogenic shock (OR, 2.25; 95% CI, 1.22-4.16; P = .009), and pulmonary embolism (OR, 16.25; 95% CI, 1.23-214.56; P = .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.