Registered Cardiac Electrophysiology Specialist (RCES) Practice Exam

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• What is the primary purpose of tagging in 3D mapping during electrophysiology procedures?
• Which of the following lists the three cusps of the aortic valve?
• If an EPS reveals inducible atrial flutter as part of a substrate, what is the most likely clinical implication?
• The crista terminalis courses caudally along which aspect of the right atrium?
• Naxos disease is characterized by ARVD features plus which skin/hair findings?
• What is the automaticity rate of the Purkinje fibers?
• Which brand name corresponds to the reversal agent for benzodiazepines?
• How is anticoagulation managed in patients with mechanical valves undergoing LA ablation with warfarin continuation?
• Long-term anticoagulation decisions after AF ablation should be guided by which factors?
• What is the difference between activation mapping and substrate mapping in VT ablation?
• What is Arrhythmogenic Right Ventricular Dysplasia (ARVD) best described as?
• What does the QT interval represent?
• Which statement best describes the relationship between conduction velocity and repolarization for the fast vs slow pathways?
• What is the hallmark of first-degree AV block on ECG?
• What is the recommended action if a steam pop occurs during RF ablation?
• Which valves are semilunar valves that open during ventricular systole?
• Which block is most clearly an indication for pacemaker therapy?
• Which finding on imaging best indicates pulmonary vein stenosis after atrial fibrillation ablation?
• Precordial concordance on ECG is diagnostic of ventricular tachycardia when the QRS complexes in V1-V6 are which of the following?
• Which statement describes the Vein of Marshall?
• During LA ablation in patients with mechanical valves, what ACT target is recommended during the procedure?
• What is the primary lesion set for AF ablation?
• The T wave on an ECG corresponds to which cardiac event?
• The pulmonary veins drain into which chamber?
• What is the objective of programmed electrical stimulation with extrastimuli during EPS?
• During tamponade management, which action is prioritized?
• What is a common sign of catheter lead fracture during device interrogation and how is it addressed?
• After AF ablation in a patient with elevated stroke risk, what is the recommended post-procedure anticoagulation plan?
• The QRS complex on an ECG corresponds to which cardiac event?
• On which catheter would you first see premature ventricular contractions?
• Compare RF and cryo ablation in terms of lesion creation and risk profile.
• How does the ALARA principle influence fluoroscopy use in EP labs?
• What is the moderator band?
• Which conduction tissue has a conduction velocity of 0.4 m/s?
• Which coronary artery supplies the SA node usually via its nodal branch?
• Extrastimulus pacing from the HRA catheter is used to determine which parameters?
• What does the PR interval represent?
• Which term describes the electrical activity across the heart during depolarization and repolarization?
• Which statement about the AV node location is true?
• True or False: administering adenosine will terminate Atrial Tachycardia?
• What testing confirms lead integrity during pacing lead assessment?
• What is the formula to convert Fahrenheit to Celsius?
• Which statement best describes the role of nonfluoroscopic mapping in EP?
• What immediate steps are taken if tamponade occurs during an EP ablation?
• Define HV interval and its clinical implication when prolonged.
• Name two energy modalities used for EP ablation and a key advantage of each.
• Eustachian valve in fetal circulation directs blood flow from the inferior vena cava to the left atrium via which structure?
• Which pathway tends to repolarize more slowly?
• Where do you measure the His?
• A sinus rhythm with a consistently prolonged PR interval and all P waves followed by QRS represents which condition?
• Which ERP defines the longest S1 S2 interval that fails to conduct to the ventricle?
• Which valves are the atrioventricular (AV) valves?
• What is the acute endpoint of pulmonary vein isolation?
• Which conduction tissue has a conduction velocity of 1 m/s?
• Which interval reflects AV nodal conduction and which reflects His-Purkinje conduction?
• What is the purpose of electroanatomic mapping in EP?
• What is the primary purpose of an invasive electrophysiology study (EPS)?
• Where is the foramen ovale located?
• Which statement best describes the role of non-fluoroscopic mapping in EP procedures?
• Which statement differentiates sinus node pause from sinus exit block?
• What is the purpose of pace-mapping during VT or focal atrial tachycardia ablation?
• Which combination best describes the fast pathway's conduction and repolarization characteristics?
• What ACT target is recommended during most left-sided EP procedures?
• What is the normal AH interval?
• What does contact force sensing do in modern EP ablation?
• How can typical AVNRT be distinguished from AVRT with WPW during EP?
• Which safety considerations are involved when using multi-electrode mapping catheters?
• Which term describes the electrical activity generated by the SA node?
• What is a steam pop and what risks does it pose during RF ablation?
• The QT interval reflects which sequence of ventricular activity?
• After AF ablation, how long is long-term anticoagulation generally considered based on stroke risk?
• Which AVRT form is more common?
• In AVNRT, what safety risk near the slow pathway should be anticipated?
• If Celsius is 37, what is Fahrenheit using F = (9/5)C + 32?
• Which drugs are Class Ia antiarrhythmic drugs?
• In PV isolation, exit block is defined as which?
• How should a steam pop be handled during RF ablation?
• What is the formula for calculating heart rate from the RR interval in milliseconds?
• What is considered the upper limit of the normal QRS interval?
• True or False: An HV interval of 120 ms would be an indication for a pacemaker?
• Antedromic conduction in AVRT is characterized by?
• Left-sided ablation, such as for atrial fibrillation, is enabled by which approach?
• Where is the cavotricuspid isthmus located?
• Which catheter is used to record the LA and LV?
• The His bundle potential on an intracardiac tracing is identified by which combination of events?
• What is the most posterior chamber of the heart?
• What is the normal HV interval?
• The Vein of Marshall is located anterior to which structure and can be a source of atrial fibrillation?
• In a rhythm with complete heart block, what is observed regarding the relationship between P waves and QRS complexes?
• How is the fast pathway defined?
• Extra-stimulus pacing from the HRA catheter will allow you to determine which electrophysiological properties?
• What is the most common mechanism for tachyarrhythmias?
• The coronary sinus empties into which chamber?
• How does imaging integration (CT/MRI) assist EP mapping and ablation planning?
• Which structures are typically visualized with CT or MRI imaging to support atrial fibrillation ablation planning?
• Which endpoint confirms complete cavotricuspid isthmus (CTI) ablation during typical flutter ablation?
• The absolute refractory period is the period of time when a stimulus of sufficient strength can initiate an Action Potential.
• What are common sedation considerations in the EP lab?
• Compared with the fast pathway, the slow pathway conducts impulses at what rate?
• When is it appropriate to resume or start antiarrhythmic drugs after AF ablation?
• Which nerve needs to be avoided when ablating near the right pulmonary veins?
• Where is the aortic valve located?
• What late complication is associated with pulmonary vein isolation that requires surveillance?
• Which pathway repolarizes slowly?
• What does scar homogenization refer to in VT ablation?
• What is the definition of AERP?
• What sterile technique practices are essential in the EP lab?
• What are the indications for epicardial access in EP ablation?
• What is transseptal puncture and what is it used for in EP?
• Adenosine as an antiarrhythmic is categorized as which class?
• In Ohm's Law, which expressions correctly relate voltage (V), current (I), and resistance (R)?
• The two primary cardiac responses to sympathetic discharge are which pair?
• What is the typical approach to a patient with inappropriate ICD shocks?
• In normal AV nodal conduction, which pathway predominantly conducts impulses to the ventricles?
• What is the common mechanism for monomorphic VT in ischemic cardiomyopathy seen in EPS?
• Which ion influx predominates during the plateau phase of the ventricular action potential?
• What is the most anterior chamber of the heart?
• What is the conduction velocity of the SA node?
• QTc thresholds are sex-specific.
• What is Bachmann's bundle?
• Koch's triangle is best described as which of the following?
• During phase 2 of the cardiac action potential, what ion is responsible for heart muscle contraction?
• Where is the pulmonic valve located?
• In the NBG Device code, the second letter refers to which of the following?
• What is the formula to convert Celsius to Fahrenheit?
• What measures reduce infection risk in the EP lab beyond sterile technique?
• Which items are included in the typical pre-procedure assessment for EP ablation?
• During a sinus node pause, which event occurs?
• Which of the following is NOT a component of the triangle of Koch?
• What is a limitation of pace-mapping when identifying VT origin?
• How do VT ablation strategies differ from AF ablation strategies?
• What best describes a bystander pathway?
• Which region is most commonly ablated during typical atrial flutter ablation?
• Which approaches help minimize radiation exposure during EP procedures?
• Which statement best describes image integration in reducing contrast use during left atrial procedures?
• ARVD is best described as which of the following?
• Where is the AV node located?
• Which are the two types of afterdepolarizations?
• Which structure forms a boundary of the triangle of Koch together with the CS ostium?
• Where is slow-pathway modification usually targeted in AVNRT?
• How many criteria are needed to sustain a reentry circuit?
• Which medication is used to reverse Midazolam (Versed)?
• Which pathway repolarizes quickly?
• What are the irregular bands of tissue projecting from the inner surfaces of the ventricles called?
• Naxos disease includes palmoplantar keratoderma and which hair feature?
• AVNERP is defined as which of the following?
• What is the normal PA interval?
• The Eustachian ridge is a remnant of which valve and where is it located?
• A QRS duration of 125 ms is considered normal.
• Early afterdepolarizations (EADs) typically occur during which phases of the cardiac action potential?
• Which of the following best explains cryoablation’s safety advantage during EP procedures?
• What is tachycardia-induced cardiomyopathy and how can EP therapy help?
• What are Class I antiarrhythmic drugs?
• How many leaflets does the tricuspid valve have?
• In antedromic AVRT, the impulse travels down the accessory pathway and up the AV node. Which option describes this pattern?
• In VT ablation, what role does hemodynamic stability play?
• Which statement best describes reentry as a VT mechanism?
• Which imaging modality is commonly used to evaluate pulmonary vein ostia after AF ablation?
• The resting membrane potential of the ventricular myocardium is within which range?
• The Eustachian ridge is located posterior to which structure?
• Which structures define the boundaries of the triangle of Koch?
• Which class of antiarrhythmic drugs affect the SA and AV nodes?
• What considerations apply when using contrast in left atrial procedures for patients with chronic kidney disease?
• Which statement best describes a third-degree AV block?
• Where is the tricuspid valve located?
• In Ohm's Law, V stands for what?
• Where is the coronary sinus located and what does it do?
• Which pathway sends impulses to the ventricles the majority of the time?
• What is activation mapping and what information does it provide during tachycardia?
• What is retrograde AVNERP defined as?
• Which statement describes a requirement for sustaining a reentry circuit?
• Where is the crista terminalis located?
• The right atrial appendage is a common site for placement of atrial leads in pacemakers and defibrillators. Where is it located?
• From which chamber does the pulmonary artery originate?
• How is the slow pathway defined?
• In sinus exit block, the typical pause length is how many P-P intervals?
• What is the only means of normal conduction from the atrium to the ventricles?
• The Thebesian valve is located at the ostium of which structure?
• What is the definition of AVNERP?
• Afterdepolarizations are best defined as?
• During atrial fibrillation ablation, which measurement is used to monitor anticoagulation status intra-procedurally?
• Which structure is located between the left atrium and left ventricle?
• How does remote device monitoring improve EP patient care?
• Adenosine is most reliably used to terminate tachycardias that depend on which structure?
• What is the cause of inappropriate sinus tachycardia?
• What is a key advantage of cryoablation near the AV node?
• When capture beats or fusion beats are observed on an ECG, what is the most likely rhythm?
• A ventricular tachycardia with left bundle branch block morphology typically suggests origin from which ventricle?
• Referring to V=IR, reducing the voltage by half will do what to the resistance?
• The P wave on an ECG represents which cardiac event?
• What is the conduction velocity of the AV node?
• How are PV entrance and exit blocks assessed during AF ablation?
• What is the emergency management approach if there is suspected coronary artery injury during EP ablation?
• SNRT is used to evaluate the health of which cardiac structure?
• Iso-osmolar contrast agents in chronic kidney disease: what is true?
• Where is the mitral valve located?
• Which statement correctly describes the ventricular resting membrane potential range?
• What is the most anterior cardiac valve?
• What is VAERP?
• What is the result of ablating a bystander pathway?
• If ventricular tachycardia originates in the left ventricle, what is the expected morphology in lead V1?
• A completely negative LBBB appearance on lead V1 indicates VT origin from which chamber?
• Which ERP is defined as the longest S1-S2 that fails to conduct to the atrium?
• Which structure is associated with thrombus in patients with atrial fibrillation?
• How is anticoagulation managed in patients with mechanical valves undergoing left atrial ablation?
• Which interval is defined as the longest S1 S2 interval that fails to result in ventricular depolarization?
• Which imaging modality is commonly used to guide transseptal puncture?
• Which interval has a normal range of 25-55 ms?
• Which refractory period of the AV node lengthens with pacing, and results in blocking of conduction to the ventricles?
• Which combination best describes the slow pathway's conduction and repolarization characteristics?
• What is the conduction velocity of the Purkinje fibers?
• Which medication is NOT a Class Ia antiarrhythmic drug?
• Which interval is the longest S1 S2 interval that fails to capture the ventricle?
• If lead insulation is fractured, lead impedance will:
• Which ERP defines the longest S1 S2 interval that fails to conduct to the atrium?
• If conduction occurs via the slow pathway, how does the conduction time compare to the fast pathway?
• Loss of capture in a pacemaker/ICD patient indicates that the pacing stimulus fails to generate a heartbeat. What is the first step?
• Which pathway is responsible for rapid propagation to the ventricles when fast conduction is advantageous?
• What is the only artery that carries deoxygenated blood?
• Purkinje fibers serve as the final backup pacemaker to the SA node.
• The right ventricle’s thick walls reflect its role in pumping blood to which circulation?
• Where is the SA node located?
• In sinus exit block, what occurs?
• The pulmonic valve is described as being close to which anatomical landmark?
• What is the normal QTc threshold for women?
• The Thebesian valve is located at the ostium of which vessel?
• What is a normal HBE interval?
• What is the most common location of outflow tract ventricular tachycardia?
• What is VERP?
• Which band houses part of the right bundle branch?
• What is AVERP?
• Which refractory period of atrial and ventricular tissue shortens with pacing, allowing introduction of premature beats?
• What is the standard anticoagulation approach around AF ablation?
• Adenosine is an example of a class ___ antiarrhythmic
• The right atrial appendage lies in which relation to the fossa ovalis?
• What landmark is targeted for transseptal puncture in left atrial EP procedures?
• Which class of antiarrhythmic drugs were studied in the Cast Trial?
• Orthodromic conduction in AVRT is characterized by?
• Which evaluations comprise the typical pre-procedure assessment for EP ablation?