IBHRE CERTIFIED ELECTROPHYSIOLOGY SPECIALIST (CEPS) EXAM
PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES Q&A INSTANT DOWNLOAD PDF
140 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Synthesize electrophysiologic principles to interpret complex intracardiac recordings and mapping data
2 Apply evidence-based strategies for ablation of complex arrhythmias, including atrial fibrillation and
ventricular tachycardia
3 Demonstrate expert-level proficiency in cardiac device programming, troubleshooting, and remote
monitoring
4 Integrate hemodynamic and electrophysiologic data to manage patients with advanced heart failure and
arrhythmias
5 Critically evaluate and apply current guidelines and landmark trials in clinical decision-making
6 IBHRE Certified Electrophysiology Specialist
7 CEPS
8 Exam Practice Questions And Correct Answers
9 Verified Answers
10 Plus Rationales Q&A Instant Download Pdf
11 Foundations of Cardiac Electrophysiology and Device Therapy
12 Applied Cardiac Electrophysiology and Device Therapy
13 Advanced Cardiac Electrophysiology and Device Therapy
14 Cardiac Electrophysiology and Device Therapy Review
Page 1
,Q1 SYNTHESIZE ELECTROPHYSIOLOGIC PRINCIPLES TO INTERPRET COMPLEX
INTRACARDIAC RECORDINGS AND MAPPING DATA
During an accessory pathway ablation, a retrograde aortic approach is used.
Which finding best indicates a left anterolateral (mitral annular) accessory
pathway location?
A. Earliest retrograde atrial activation at the coronary sinus ostium
B. Earliest retrograde atrial activation at the distal coronary sinus (CS 9-10) CORRECT
C. Earliest retrograde atrial activation at the proximal coronary sinus (CS 1-2) and a positive
delta wave in lead V1
D. Earliest retrograde atrial activation at the His bundle region with concentric activation
RATIONALE: A left anterolateral pathway inserts on the mitral annulus, near the left atrial
appendage, which is closest to the distal coronary sinus electrodes (CS 9-10). CS ostium
activation suggests a posteroseptal pathway; proximal CS plus positive delta in V1 suggests a
right-sided or septal pathway; His bundle activation suggests an anteroseptal pathway. Thus,
distal CS timing is the best indicator.
Q2 SYNTHESIZE ELECTROPHYSIOLOGIC PRINCIPLES TO INTERPRET COMPLEX
INTRACARDIAC RECORDINGS AND MAPPING DATA
A patient with a dual-chamber ICD receives a shock. Interrogation shows an
episode of ventricular tachycardia (VT) at 200 bpm, but no therapy was delivered.
The device was programmed with a monitor zone at 180 bpm and therapy zone at
220 bpm. What is the most likely cause of the shock?
A. Inappropriate shock due to supraventricular tachycardia (SVT) in the monitor zone
B. Inappropriate shock due to T-wave oversensing in the monitor zone
C. Appropriate shock for VT that accelerated to exceed the therapy zone CORRECT
D. Inappropriate shock due to electromagnetic interference (EMI) in the monitor zone
RATIONALE: The monitor zone (180 bpm) withholds therapy, but if VT accelerates above the
therapy zone (220 bpm), the device delivers a shock. The scenario describes VT at 200 bpm with
no therapy-this is consistent with monitor zone behavior. The shock must have occurred when
the VT rate crossed the therapy threshold. Other causes (SVT, T-wave oversensing, EMI) would
typically show different electrogram characteristics and are less likely given the programmed
zones.
Page 2
,Q3 SYNTHESIZE ELECTROPHYSIOLOGIC PRINCIPLES TO INTERPRET COMPLEX
INTRACARDIAC RECORDINGS AND MAPPING DATA
In a patient undergoing catheter ablation for scar-related ventricular tachycardia,
which mapping technique is most useful to identify the critical isthmus when the
VT is hemodynamically unstable?
A. Activation mapping during VT
B. Entrainment mapping during VT
C. Substrate mapping during sinus rhythm with late potentials and pace mapping CORRECT
D. Non-contact mapping to reconstruct endocardial activation
RATIONALE: For hemodynamically unstable VT, activation and entrainment mapping are not
feasible. Substrate mapping during sinus rhythm identifies abnormal electrograms (late
potentials, fractionated signals) and uses pace mapping to approximate the critical isthmus.
Non-contact mapping can be used but is less commonly available and less direct.
Substrate-based ablation is the standard approach for unmappable VT.
Q4 SYNTHESIZE ELECTROPHYSIOLOGIC PRINCIPLES TO INTERPRET COMPLEX
INTRACARDIAC RECORDINGS AND MAPPING DATA
A patient with a cardiac resynchronization therapy defibrillator (CRT-D) shows an
increase in right ventricular (RV) pacing threshold from 0.5V to 2.5V at 0.4ms.
Chest X-ray shows lead dislodgement. What is the most appropriate immediate
management?
A. Increase RV pacing output to 3.5V and reprogram
B. Schedule lead revision in 1 month
C. Reposition the lead in the electrophysiology lab CORRECT
D. Switch to LV-only pacing and disable RV pacing
RATIONALE: Lead dislodgement requires prompt repositioning to maintain device function and
patient safety. Increasing output may be temporary but does not address the dislodgement.
Delaying revision risks loss of capture and potential complications. LV-only pacing is not a
substitute for RV pacing in a CRT-D and does not address the dislodged lead.
Page 3
, Q5 SYNTHESIZE ELECTROPHYSIOLOGIC PRINCIPLES TO INTERPRET COMPLEX
INTRACARDIAC RECORDINGS AND MAPPING DATA
During an atrial fibrillation (AF) ablation, a circular mapping catheter is placed in
the left superior pulmonary vein (LSPV). Which finding is most consistent with a
non-ostial electrical connection requiring further ablation?
A. Spontaneous pulmonary vein potentials with a left atrial (LA) appendage pacing maneuver
CORRECT
B. Loss of pulmonary vein potentials after a single wide antral circumferential ablation
C. Pulmonary vein potentials present only during coronary sinus pacing
D. Pulmonary vein potentials that are dissociated from the LA during sinus rhythm
RATIONALE: Non-ostial connections are indicated by residual PV potentials that are not
eliminated by ostial ablation. Spontaneous PV potentials during LA appendage pacing suggest
an extra-ostial focus or connection. Loss of PV potentials after ablation indicates successful
isolation. PV potentials only during CS pacing may indicate far-field capture. Dissociated PV
potentials are a sign of complete isolation, not a connection.
Q6 SYNTHESIZE ELECTROPHYSIOLOGIC PRINCIPLES TO INTERPRET COMPLEX
INTRACARDIAC RECORDINGS AND MAPPING DATA
A patient with a dual-chamber pacemaker (DDD mode) develops
pacemaker-mediated tachycardia (PMT) after a premature ventricular contraction.
Which programmed feature is most likely to terminate this episode?
A. Ventricular safety pacing
B. Rate-responsive pacing
C. Post-ventricular atrial refractory period (PVARP) extension after a sensed PVC CORRECT
D. Atrial tachycardia response (ATR) with mode switching
RATIONALE: PMT is initiated by retrograde P waves sensed by the atrial channel. Extending
PVARP after a sensed PVC makes the retrograde P wave fall into the refractory period,
preventing tracking and terminating PMT. Ventricular safety pacing prevents crosstalk, not PMT.
Rate-responsive pacing and ATR mode switching are not specific for PMT termination.
Page 4
PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES Q&A INSTANT DOWNLOAD PDF
140 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Synthesize electrophysiologic principles to interpret complex intracardiac recordings and mapping data
2 Apply evidence-based strategies for ablation of complex arrhythmias, including atrial fibrillation and
ventricular tachycardia
3 Demonstrate expert-level proficiency in cardiac device programming, troubleshooting, and remote
monitoring
4 Integrate hemodynamic and electrophysiologic data to manage patients with advanced heart failure and
arrhythmias
5 Critically evaluate and apply current guidelines and landmark trials in clinical decision-making
6 IBHRE Certified Electrophysiology Specialist
7 CEPS
8 Exam Practice Questions And Correct Answers
9 Verified Answers
10 Plus Rationales Q&A Instant Download Pdf
11 Foundations of Cardiac Electrophysiology and Device Therapy
12 Applied Cardiac Electrophysiology and Device Therapy
13 Advanced Cardiac Electrophysiology and Device Therapy
14 Cardiac Electrophysiology and Device Therapy Review
Page 1
,Q1 SYNTHESIZE ELECTROPHYSIOLOGIC PRINCIPLES TO INTERPRET COMPLEX
INTRACARDIAC RECORDINGS AND MAPPING DATA
During an accessory pathway ablation, a retrograde aortic approach is used.
Which finding best indicates a left anterolateral (mitral annular) accessory
pathway location?
A. Earliest retrograde atrial activation at the coronary sinus ostium
B. Earliest retrograde atrial activation at the distal coronary sinus (CS 9-10) CORRECT
C. Earliest retrograde atrial activation at the proximal coronary sinus (CS 1-2) and a positive
delta wave in lead V1
D. Earliest retrograde atrial activation at the His bundle region with concentric activation
RATIONALE: A left anterolateral pathway inserts on the mitral annulus, near the left atrial
appendage, which is closest to the distal coronary sinus electrodes (CS 9-10). CS ostium
activation suggests a posteroseptal pathway; proximal CS plus positive delta in V1 suggests a
right-sided or septal pathway; His bundle activation suggests an anteroseptal pathway. Thus,
distal CS timing is the best indicator.
Q2 SYNTHESIZE ELECTROPHYSIOLOGIC PRINCIPLES TO INTERPRET COMPLEX
INTRACARDIAC RECORDINGS AND MAPPING DATA
A patient with a dual-chamber ICD receives a shock. Interrogation shows an
episode of ventricular tachycardia (VT) at 200 bpm, but no therapy was delivered.
The device was programmed with a monitor zone at 180 bpm and therapy zone at
220 bpm. What is the most likely cause of the shock?
A. Inappropriate shock due to supraventricular tachycardia (SVT) in the monitor zone
B. Inappropriate shock due to T-wave oversensing in the monitor zone
C. Appropriate shock for VT that accelerated to exceed the therapy zone CORRECT
D. Inappropriate shock due to electromagnetic interference (EMI) in the monitor zone
RATIONALE: The monitor zone (180 bpm) withholds therapy, but if VT accelerates above the
therapy zone (220 bpm), the device delivers a shock. The scenario describes VT at 200 bpm with
no therapy-this is consistent with monitor zone behavior. The shock must have occurred when
the VT rate crossed the therapy threshold. Other causes (SVT, T-wave oversensing, EMI) would
typically show different electrogram characteristics and are less likely given the programmed
zones.
Page 2
,Q3 SYNTHESIZE ELECTROPHYSIOLOGIC PRINCIPLES TO INTERPRET COMPLEX
INTRACARDIAC RECORDINGS AND MAPPING DATA
In a patient undergoing catheter ablation for scar-related ventricular tachycardia,
which mapping technique is most useful to identify the critical isthmus when the
VT is hemodynamically unstable?
A. Activation mapping during VT
B. Entrainment mapping during VT
C. Substrate mapping during sinus rhythm with late potentials and pace mapping CORRECT
D. Non-contact mapping to reconstruct endocardial activation
RATIONALE: For hemodynamically unstable VT, activation and entrainment mapping are not
feasible. Substrate mapping during sinus rhythm identifies abnormal electrograms (late
potentials, fractionated signals) and uses pace mapping to approximate the critical isthmus.
Non-contact mapping can be used but is less commonly available and less direct.
Substrate-based ablation is the standard approach for unmappable VT.
Q4 SYNTHESIZE ELECTROPHYSIOLOGIC PRINCIPLES TO INTERPRET COMPLEX
INTRACARDIAC RECORDINGS AND MAPPING DATA
A patient with a cardiac resynchronization therapy defibrillator (CRT-D) shows an
increase in right ventricular (RV) pacing threshold from 0.5V to 2.5V at 0.4ms.
Chest X-ray shows lead dislodgement. What is the most appropriate immediate
management?
A. Increase RV pacing output to 3.5V and reprogram
B. Schedule lead revision in 1 month
C. Reposition the lead in the electrophysiology lab CORRECT
D. Switch to LV-only pacing and disable RV pacing
RATIONALE: Lead dislodgement requires prompt repositioning to maintain device function and
patient safety. Increasing output may be temporary but does not address the dislodgement.
Delaying revision risks loss of capture and potential complications. LV-only pacing is not a
substitute for RV pacing in a CRT-D and does not address the dislodged lead.
Page 3
, Q5 SYNTHESIZE ELECTROPHYSIOLOGIC PRINCIPLES TO INTERPRET COMPLEX
INTRACARDIAC RECORDINGS AND MAPPING DATA
During an atrial fibrillation (AF) ablation, a circular mapping catheter is placed in
the left superior pulmonary vein (LSPV). Which finding is most consistent with a
non-ostial electrical connection requiring further ablation?
A. Spontaneous pulmonary vein potentials with a left atrial (LA) appendage pacing maneuver
CORRECT
B. Loss of pulmonary vein potentials after a single wide antral circumferential ablation
C. Pulmonary vein potentials present only during coronary sinus pacing
D. Pulmonary vein potentials that are dissociated from the LA during sinus rhythm
RATIONALE: Non-ostial connections are indicated by residual PV potentials that are not
eliminated by ostial ablation. Spontaneous PV potentials during LA appendage pacing suggest
an extra-ostial focus or connection. Loss of PV potentials after ablation indicates successful
isolation. PV potentials only during CS pacing may indicate far-field capture. Dissociated PV
potentials are a sign of complete isolation, not a connection.
Q6 SYNTHESIZE ELECTROPHYSIOLOGIC PRINCIPLES TO INTERPRET COMPLEX
INTRACARDIAC RECORDINGS AND MAPPING DATA
A patient with a dual-chamber pacemaker (DDD mode) develops
pacemaker-mediated tachycardia (PMT) after a premature ventricular contraction.
Which programmed feature is most likely to terminate this episode?
A. Ventricular safety pacing
B. Rate-responsive pacing
C. Post-ventricular atrial refractory period (PVARP) extension after a sensed PVC CORRECT
D. Atrial tachycardia response (ATR) with mode switching
RATIONALE: PMT is initiated by retrograde P waves sensed by the atrial channel. Extending
PVARP after a sensed PVC makes the retrograde P wave fall into the refractory period,
preventing tracking and terminating PMT. Ventricular safety pacing prevents crosstalk, not PMT.
Rate-responsive pacing and ATR mode switching are not specific for PMT termination.
Page 4
