IBHRE CCDS EXAM/INTERNATIONAL BOARD OF HEART
RHYTHM EXAMINERS CERTIFIED CARDIAC DEVICE SPECIALIST
ACTUAL EXAM 2026-2027 COMPLETE AND ACCURATE EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (100% CORRECT VERIFIED ANSWERS) LATEST
UPDATED VERSION EDITION 2026 GUARANTEED PASS A+
|INSTANT DOWNLOAD PDF
A 68-year-old male with a dual-chamber pacemaker presents for routine
interrogation. The device is programmed DDD with a Certified Cardiac
Device Specialist lower rate of 60 ppm and an AV delay of 180ms. His
intrinsic atrial rate is 75 bpm with intact AV conduction. Which of the
following best describes the expected pacing behavior?
A) Atrial pacing at 60 ppm with ventricular sensing
B) Ventricular pacing at 60 ppm with atrial sensing
C) Atrial sensing with ventricular pacing after 180 ms
D) Atrial and ventricular sensing with no pacing
E) Atrial pacing at 75 ppm with ventricular sensing
Answer: D
In DDD mode, the device senses both chambers and paces only when intrinsic
activity is absent. Since the atrial rate is above the lower rate and AV conduction is
intact, the device will sense both atrial and ventricular events and inhibit pacing.
A patient with a CRT-D device has a measured QRS duration of 160 ms on
surface ECG during biventricular pacing. Interrogation shows 100%
,biventricular pacing. Which of the following interventions is most likely to
narrow the paced QRS further?
A) Increase the AV delay
B) Decrease the V-V offset
C) Adjust the left ventricular pacing vector
D) Program the lower rate to 70 ppm
E) Enable rate-responsive AV delay
Answer: C
The paced QRS morphology and duration are heavily influenced by the left
ventricular pacing site. Changing the LV pacing vector can alter the activation
sequence and potentially narrow the QRS complex more effectively than timing cycle
changes.
During a device check, the magnet rate of a patient's pacemaker is noted to be
85 bpm. The patient's intrinsic rhythm is atrial fibrillation with a ventricular
rate of 110 bpm. What is the most appropriate interpretation?
A) The device is functioning normally in VVI mode
B) The magnet has activated asynchronous pacing
C) The device is exhibiting pacemaker-mediated tachycardia
D) The battery is at end of life
E) The device is in safe mode
Answer: B
Applying a magnet typically converts the device to an asynchronous pacing mode
(e.g., VOO or DOO) at a fixed magnet rate, overriding the sensed intrinsic rhythm.
The magnet rate of 85 bpm is within normal range for most manufacturers .
,A 72-year-old woman with a single-chamber ICD receives a shock.
Interrogation reveals that the episode was a supraventricular tachycardia with
a rate of 180 bpm. The ICD discriminated the rhythm as ventricular
tachycardia. Which of the following enhancements would most likely have
prevented this inappropriate therapy?
A) PR logic
B) Morphology discrimination
C) Onset criterion
D) Stability criterion
E) Rate branch analysis
Answer: B
Morphology discrimination compares the QRS morphology during tachycardia to
the baseline intrinsic QRS. Supraventricular tachycardias usually have similar
morphology to sinus rhythm, which would help the device correctly identify SVT
and withhold therapy.
A patient's pacemaker is programmed to VVIR at a lower rate of 60 ppm. The
sensor indicated rate is 100 ppm. The patient's intrinsic rate is 70 bpm. What is
the pacing behavior?
A) Pacing at 60 ppm
B) Pacing at 70 ppm
C) Pacing at 100 ppm
D) No pacing because intrinsic rate exceeds lower rate
E) Pacing at the sensor rate only if intrinsic rate falls below 60
Answer: C
, In VVIR mode, the sensor can increase the pacing rate above the lower rate based on
activity or metabolic demand. The device will pace at the sensor-indicated rate if it
exceeds the intrinsic rate.
Which of the following electrocardiographic findings is most characteristic of
ventricular pacing from the right ventricular apex?
A) Left bundle branch block pattern with left axis deviation
B) Left bundle branch block pattern with right axis deviation
C) Right bundle branch block pattern with left axis deviation
D) Right bundle branch block pattern with right axis deviation
E) Normal QRS with no axis deviation
Answer: A
Right ventricular apical pacing results in a left bundle branch block pattern
(dominant S wave in V1) and left axis deviation (negative QRS in leads I and aVF)
because the depolarization wavefront originates from the right side and travels
slowly through the myocardium.
A patient with an ICD has a detection zone programmed for ventricular
fibrillation at rates >220 bpm. The device charges and delivers a shock. Which
of the following capacitor voltages is typically used for a maximum-energy
shock in a modern ICD?
A) 200 V
B) 350 V
C) 500 V
D) 750 V
E) 1000 V
Answer: D
RHYTHM EXAMINERS CERTIFIED CARDIAC DEVICE SPECIALIST
ACTUAL EXAM 2026-2027 COMPLETE AND ACCURATE EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (100% CORRECT VERIFIED ANSWERS) LATEST
UPDATED VERSION EDITION 2026 GUARANTEED PASS A+
|INSTANT DOWNLOAD PDF
A 68-year-old male with a dual-chamber pacemaker presents for routine
interrogation. The device is programmed DDD with a Certified Cardiac
Device Specialist lower rate of 60 ppm and an AV delay of 180ms. His
intrinsic atrial rate is 75 bpm with intact AV conduction. Which of the
following best describes the expected pacing behavior?
A) Atrial pacing at 60 ppm with ventricular sensing
B) Ventricular pacing at 60 ppm with atrial sensing
C) Atrial sensing with ventricular pacing after 180 ms
D) Atrial and ventricular sensing with no pacing
E) Atrial pacing at 75 ppm with ventricular sensing
Answer: D
In DDD mode, the device senses both chambers and paces only when intrinsic
activity is absent. Since the atrial rate is above the lower rate and AV conduction is
intact, the device will sense both atrial and ventricular events and inhibit pacing.
A patient with a CRT-D device has a measured QRS duration of 160 ms on
surface ECG during biventricular pacing. Interrogation shows 100%
,biventricular pacing. Which of the following interventions is most likely to
narrow the paced QRS further?
A) Increase the AV delay
B) Decrease the V-V offset
C) Adjust the left ventricular pacing vector
D) Program the lower rate to 70 ppm
E) Enable rate-responsive AV delay
Answer: C
The paced QRS morphology and duration are heavily influenced by the left
ventricular pacing site. Changing the LV pacing vector can alter the activation
sequence and potentially narrow the QRS complex more effectively than timing cycle
changes.
During a device check, the magnet rate of a patient's pacemaker is noted to be
85 bpm. The patient's intrinsic rhythm is atrial fibrillation with a ventricular
rate of 110 bpm. What is the most appropriate interpretation?
A) The device is functioning normally in VVI mode
B) The magnet has activated asynchronous pacing
C) The device is exhibiting pacemaker-mediated tachycardia
D) The battery is at end of life
E) The device is in safe mode
Answer: B
Applying a magnet typically converts the device to an asynchronous pacing mode
(e.g., VOO or DOO) at a fixed magnet rate, overriding the sensed intrinsic rhythm.
The magnet rate of 85 bpm is within normal range for most manufacturers .
,A 72-year-old woman with a single-chamber ICD receives a shock.
Interrogation reveals that the episode was a supraventricular tachycardia with
a rate of 180 bpm. The ICD discriminated the rhythm as ventricular
tachycardia. Which of the following enhancements would most likely have
prevented this inappropriate therapy?
A) PR logic
B) Morphology discrimination
C) Onset criterion
D) Stability criterion
E) Rate branch analysis
Answer: B
Morphology discrimination compares the QRS morphology during tachycardia to
the baseline intrinsic QRS. Supraventricular tachycardias usually have similar
morphology to sinus rhythm, which would help the device correctly identify SVT
and withhold therapy.
A patient's pacemaker is programmed to VVIR at a lower rate of 60 ppm. The
sensor indicated rate is 100 ppm. The patient's intrinsic rate is 70 bpm. What is
the pacing behavior?
A) Pacing at 60 ppm
B) Pacing at 70 ppm
C) Pacing at 100 ppm
D) No pacing because intrinsic rate exceeds lower rate
E) Pacing at the sensor rate only if intrinsic rate falls below 60
Answer: C
, In VVIR mode, the sensor can increase the pacing rate above the lower rate based on
activity or metabolic demand. The device will pace at the sensor-indicated rate if it
exceeds the intrinsic rate.
Which of the following electrocardiographic findings is most characteristic of
ventricular pacing from the right ventricular apex?
A) Left bundle branch block pattern with left axis deviation
B) Left bundle branch block pattern with right axis deviation
C) Right bundle branch block pattern with left axis deviation
D) Right bundle branch block pattern with right axis deviation
E) Normal QRS with no axis deviation
Answer: A
Right ventricular apical pacing results in a left bundle branch block pattern
(dominant S wave in V1) and left axis deviation (negative QRS in leads I and aVF)
because the depolarization wavefront originates from the right side and travels
slowly through the myocardium.
A patient with an ICD has a detection zone programmed for ventricular
fibrillation at rates >220 bpm. The device charges and delivers a shock. Which
of the following capacitor voltages is typically used for a maximum-energy
shock in a modern ICD?
A) 200 V
B) 350 V
C) 500 V
D) 750 V
E) 1000 V
Answer: D
