IBHRE CERTIFICATION EVALUATION 2026
COMPLETE QUESTIONS AND ACCURATE
ANSWERS
◉ Pacemaker syndrome
Answer: combination of symptoms occuring with v-pacing that are
relieved by restoring AV synchrony (experienced by 25% of vpaced
patients to a degree
◉ fallback
Answer: -purpose is to avoid rapid and prolonged vpacing during
atrial arrhythmias
-decouples A and V at upper rate limit
◉ rate smoothing
Answer: eliminates large beat to beat variations by not letting pacing
rate change more than a certain percentage from the next interval
◉ Percent change for rate smoothing in guidant devices
Answer: 3,6,12.5,25
◉ Rate smoothing
,Answer: looks at last r-r interval and doesn't let the next change by
more than the programmed percentage
◉ rate smoothing in atrial window
Answer: (previous R-R +/- rate smoothing value)-AV delay
◉ rate smoothing in ventricular window
Answer: (previous RR +/- rate smoothing value)
◉ Sensor upper rate behavior
Answer: -the ventricle is paced in an AV sequential fashion in
response to sensor input
-if sinus P is faster, we inhibit and start AV delays/ If sensor P rate is
faster we pace
◉ Medtronic Rate Drop Response
Answer: detects drops associated with vasovagal syncope and goes
to higher pacing rate in response to reduce symptoms
◉ Tilt table test
Answer: -a cardiovascular test used to evaluate the cause of syncope
(unexplained fainting)
-a person is brought into standing while HR and BP are monitored
, ◉ what is the outcome for a successful tilt table test?
Answer: HR increases then rapidly decreases then BP decreases
◉ Type 3 VVS
Answer: pure vasovagal response, syncope occurs before significant
brady so RDR not helpful
◉ Type 2b VVS
Answer: cardioinhibitory, most likely to respond to pacing, BP falls
after significant brady
◉ type 2a VVS
Answer: cardioinhibitory, BP falls after significant brady, may benefit
from RDR
◉ type 1 VVS
Answer: BP fall but HR stays above 40
◉ type 1a VVS
Answer: BP and HR fall almost simultaneously. May see oscillation in
rate, may benefit from RDR
COMPLETE QUESTIONS AND ACCURATE
ANSWERS
◉ Pacemaker syndrome
Answer: combination of symptoms occuring with v-pacing that are
relieved by restoring AV synchrony (experienced by 25% of vpaced
patients to a degree
◉ fallback
Answer: -purpose is to avoid rapid and prolonged vpacing during
atrial arrhythmias
-decouples A and V at upper rate limit
◉ rate smoothing
Answer: eliminates large beat to beat variations by not letting pacing
rate change more than a certain percentage from the next interval
◉ Percent change for rate smoothing in guidant devices
Answer: 3,6,12.5,25
◉ Rate smoothing
,Answer: looks at last r-r interval and doesn't let the next change by
more than the programmed percentage
◉ rate smoothing in atrial window
Answer: (previous R-R +/- rate smoothing value)-AV delay
◉ rate smoothing in ventricular window
Answer: (previous RR +/- rate smoothing value)
◉ Sensor upper rate behavior
Answer: -the ventricle is paced in an AV sequential fashion in
response to sensor input
-if sinus P is faster, we inhibit and start AV delays/ If sensor P rate is
faster we pace
◉ Medtronic Rate Drop Response
Answer: detects drops associated with vasovagal syncope and goes
to higher pacing rate in response to reduce symptoms
◉ Tilt table test
Answer: -a cardiovascular test used to evaluate the cause of syncope
(unexplained fainting)
-a person is brought into standing while HR and BP are monitored
, ◉ what is the outcome for a successful tilt table test?
Answer: HR increases then rapidly decreases then BP decreases
◉ Type 3 VVS
Answer: pure vasovagal response, syncope occurs before significant
brady so RDR not helpful
◉ Type 2b VVS
Answer: cardioinhibitory, most likely to respond to pacing, BP falls
after significant brady
◉ type 2a VVS
Answer: cardioinhibitory, BP falls after significant brady, may benefit
from RDR
◉ type 1 VVS
Answer: BP fall but HR stays above 40
◉ type 1a VVS
Answer: BP and HR fall almost simultaneously. May see oscillation in
rate, may benefit from RDR
