High atrioventricular phase index on near-field intracardiac electrogram is associated with risk of ventricular arrhythmia

The purposes of this study were to characterize and quantify concordance between consecutive atrial and ventricular activation time points through analysis of phases and to explore its association with outcomes in patients with implantable cardioverter-defibrillator (ICD). Patients with structural heart disease and dual-chamber ICDs underwent 5 min baseline right ventricular (V) near-field and atrial (A) electrogram (EGM) recording. The cross-dependencies of phase dynamics of the changes in consecutive A (AA′) and V (VV′) were quantified and the AV phase dependency index was determined. In Cox regression analysis, a high AV phase index (in the highest quartile, > 0.259) was significantly associated with higher risk of ventricular tachyarrhythmias (HR 2.84; 95% CI 1.05–7.67; P = 0.04). In conclusion, in ICD patients with structural heart disease, high sinus AV phase dependency index on EGM is associated with the risk of ventricular arrhythmia.