EP IBHRE ACTUAL CERTIFICATION
PAPER 2026 QUESTIONS WITH ANSWERS
FULL SOLUTION.
■ SACT. Answer: -Purpose is to detect delayed conduction between the
SAN and adjacent atrial tissue
-extrastim delivered at the HRA to reset sinus node then seeing how long
it takes to conduct to adjacent atrial tissue
-***Used to evaluate SAN exit block
-(Return interval - BCL)/2
-normal = 50-125 ms
■ Normal QT. Answer: around 400 ms or less
■ normal SNRT and cSNRT. Answer: SNRT <1500 ms
cSNRT <550 (SNRT should be no longer than 550 ms from normal CL)
■ Most common form of idiopathic LV VT. Answer: Verapamil sensitive
fascicular VT
-believed to be caused by reentry
-seen in SHD patients, RBBB, and left axis dev.
, ■ With differential diagnosis of VT (AVNRT, AVRT, 1:1 AFL, VT), what
is most suggestive of VT. Answer: The absence of RS waves in all
precordial leads is most suggestive of VT compared to others
■ Characteristics of bundle branch reentry VT. Answer: -H before every
V in VT with dissociated A's (His potential precedes QRS)
-HV longer (55-160 ms)
-reentry loop around the 2 main septal bundle branches
-usually a LBBB morphology due to antegrade conduction over the RBB
and retrograde conduction over LBB
-
■ Most VT in patients with structural heart disease originates as:.
Answer: Reentry in the LV
■ When is entrainment mapping most useful and why. Answer: -
ischemic VT (reentrent) and atrial flutter
-this is because we can tell if we are in the actual tachycardia circuit
-it is useful in AVNRT/AVRT to distinguish but not as useful as in VT's
and flutters to find the actual circuit
■ Entrainment: when are you in the reentry circuit. Answer: When the
PPI is equal to or within 30 ms of the TCL (so when PPI-TCL = <30 ms
PAPER 2026 QUESTIONS WITH ANSWERS
FULL SOLUTION.
■ SACT. Answer: -Purpose is to detect delayed conduction between the
SAN and adjacent atrial tissue
-extrastim delivered at the HRA to reset sinus node then seeing how long
it takes to conduct to adjacent atrial tissue
-***Used to evaluate SAN exit block
-(Return interval - BCL)/2
-normal = 50-125 ms
■ Normal QT. Answer: around 400 ms or less
■ normal SNRT and cSNRT. Answer: SNRT <1500 ms
cSNRT <550 (SNRT should be no longer than 550 ms from normal CL)
■ Most common form of idiopathic LV VT. Answer: Verapamil sensitive
fascicular VT
-believed to be caused by reentry
-seen in SHD patients, RBBB, and left axis dev.
, ■ With differential diagnosis of VT (AVNRT, AVRT, 1:1 AFL, VT), what
is most suggestive of VT. Answer: The absence of RS waves in all
precordial leads is most suggestive of VT compared to others
■ Characteristics of bundle branch reentry VT. Answer: -H before every
V in VT with dissociated A's (His potential precedes QRS)
-HV longer (55-160 ms)
-reentry loop around the 2 main septal bundle branches
-usually a LBBB morphology due to antegrade conduction over the RBB
and retrograde conduction over LBB
-
■ Most VT in patients with structural heart disease originates as:.
Answer: Reentry in the LV
■ When is entrainment mapping most useful and why. Answer: -
ischemic VT (reentrent) and atrial flutter
-this is because we can tell if we are in the actual tachycardia circuit
-it is useful in AVNRT/AVRT to distinguish but not as useful as in VT's
and flutters to find the actual circuit
■ Entrainment: when are you in the reentry circuit. Answer: When the
PPI is equal to or within 30 ms of the TCL (so when PPI-TCL = <30 ms
