EPU Electrophysiology Practice Exam

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• Substrate associated with atypical flutter is:
• Which lead is formed between the right arm and left arm with the right arm as negative and the left arm as positive?
• Which of the following is a correct set of normal interval values?
• Cardiac muscle cells are typically characterized as what in relation to pacemaker cells?
• Which of the following is a normal PR interval value?
• Which lead measures the potential difference between the right arm and left arm electrodes?
• Cryoablation injury involves which mechanisms?
• The inferior view of the heart is obtained using which of the following leads?
• A delta wave is the result of concealed retrograde conduction from the ventricle during normal sinus rhythm. True or False?
• During entrainment mapping for typical atrial flutter, pacing from which catheters could you determine concealed entrainment?
• The most common mechanism of tachycardias is the result of which mechanism of activation?
• SCL stands for the basic cycle length.
• During RF ablation of AVNRT, the appearance of junctional beats suggests that ablation is affecting the slow pathway.
• During sympathetic activation, heart rate and contractility increase.
• In a person with normal AVN, decrementing S2 by 10 ms during extrastim pacing will cause AH interval to
• Tissue injury from cryoablation is due to which mechanisms?
• In pacing studies, S1 S2 denotes the coupling interval between the baseline stimulus (S1) and the premature stimulus (S2).
• The statement that an orthodromic pathway will show a delta wave on the ECG is true.
• Which statement correctly describes the relationship of the P wave to atrial contraction?
• All of the following are found in the right atrium except which structure?
• Which structure is not considered to be found in the right atrium?
• Which structure is located posterior to the tricuspid valve?
• In a patient with AVNRT, adenosine will have any effect on the tachycardia.
• Which cells are included in the heart’s pacemaker system?
• Vagal responses can occur during pulmonary vein isolation.
• The sinoatrial (SA) node is located at which anatomical site?
• During cryoablation, microcirculatory failure contributing to tissue injury occurs during which phase?
• For ablation of AVRT, the typical target is the site of earliest fusion where atrial and ventricular activations are nearly simultaneous. Which option best describes this target?
• Performing vagal maneuvers can cause which of the following?
• Why does theSAN typically serve as the heart's pacemaker in a normal heart?
• Which term describes AF episodes that terminate spontaneously within seven days?
• Triggered activity can be caused by which mechanisms?
• Which option correctly lists the three structures that form the triangle of Koch?
• If you suspect AVNRT for an SVT EPS, which observations are consistent with typical AVNRT?
• During multifocal atrial tachycardia, the P-waves are of different morphology, because
• In AVNRT, a premature beat typically causes a unidirectional block in the fast pathway; the impulse travels down the slow pathway.
• During decremental ventricular pacing in the presence of an accessory pathway, the VA interval typically what happens?
• Blood passes from the right atrium to which chamber through the tricuspid valve?
• In electrophysiology signal processing, filtering is used to
• Which component is described as the heart of the electrophysiology lab?
• Which endpoint confirms successful ablation for typical flutter?
• All humans can conduct impulses retrograde up the AV node.
• Which electrogram type includes both local and far-field signals and represents the summation of all cardiac activity?
• During RF ablation of AVNRT, presence of junctional beats is an indication of slow pathway ablation.
• The flight-or-fight neural response that increases heart rate and contractility is called:
• HRA in mapping contexts refers to recording from which chamber?
• During phase 2 of the cardiac action potential, which process is driven by calcium influx into the cell?
• Which of the following describes the most immediate cellular effect during energy delivery?
• Which of the following have an effect on signal quality and noise?
• During retrograde activation, if the signal passes through the AV node, the VA interval would ___ due to the decremental properties of the AV node.
• Which statement best describes the relationship between the signal amplifier and the EP recording system?
• Which piece of equipment captures the X-ray to produce an image?
• To verify concealed entrainment during typical flutter, the PPI must be within ___ of TCL?
• During pacing studies in a bypass tract, eccentric activation is a hallmark of which phenomenon?
• During development, the wall of the left atrium and pulmonary veins share a common cellular lineage.
• To sustain a reentry circuit, which of the following is required?
• Typical flutter ablation location is in the which region?
• Polarity configuration, which measures activity between two sequential electrodes is referred to as
• Lack of tissue capture can be caused by which of the following?
• Which view allows to identify lateral and medial locations?
• For a patient with a left-sided bypass tract, during ventricular pacing the earliest atrial signal on the CS channel will be in which electrodes?
• CCW atrial flutter has what pattern on the CS?
• During ventricular pacing in a bypass tract, the VA interval remains unchanged. Which statement is true about this observation?
• Leads II, III, and aVF provide an inferior view of the heart.
• What does the cardiac stimulator deliver to the heart?
• Endpoint for typical flutter ablation is which of the following?
• Which of the following is NOT a criterion to initiate and sustain reentry tachycardia?
• Narrow complex tachycardia is defined by which criteria?
• The statement 'Inferior access to the right atrium is achieved through the right internal jugular vein' is true.
• Focal tachycardia can be due to which mechanisms?
• The use of irrigation of the ablation electrode has a positive effect in all the following aspects of the energy delivery except:
• Retrograde Wenckebach is a pacing phenomenon used in SVT evaluation involving which process?
• Activation mapping patterns: a focal source would be described as which of the following?
• The SA node is located at the junction of which structures?
• Where is the crista terminalis located in the heart?
• A delta wave is the result of concealed retrograde conduction from the ventricle during normal sinus rhythm. True or False?
• Which pacing modality is used to determine the ventricular effective refractory period (VERP)?
• Which of the following is NOT a mechanism of tachycardia activation?
• Repolarization occurs after depolarization and is associated with the return of the cell to its resting state.
• AVNRT ablation location is typically performed at which anatomical area?
• The ability of cardiac cells to contract or depolarize spontaneously without external influence is called
• Where is the ablation target for an accessory pathway?
• In typical AVNRT, what happens during the jump when conduction shifts from the fast pathway to the slow pathway?
• The portion of an action potential during which no impulse can initiate depolarization is called the
• In Wolff-Parkinson-White syndrome, the accessory pathway is also called the Bundle of Kent.
• Which pairing between heart chamber and its primary circulation target is incorrect?
• An atrial fibrillation episode that terminates spontaneously within seven days is best described as?
• The chordae tendineae in the right and left ventricles connect what to the papillary muscles?
• The image intensifier in X-ray imaging is used to convert X-ray photons into light to form the image.
• Which component is responsible for converting analog ECG signals into digital data?
• Orthodromic accessory pathway manifests on an ECG as a delta wave.
• Which system directly receives, records and displays all ECG/EGM signals from ECG electrodes and EP catheters?
• Adenosine will terminate AVNRT tachycardia.
• Which of the following is a normal QRS duration value?
• Jugular access is more ______ approach and femoral access is more ______.
• Typical placement of EP catheters for EPS includes which four sites?
• During cryoablation, an AV ratio of 1:4-1:10 is acceptable.
• During entrainment, the ventricle is paced at 330 ms, 20 ms faster than the tachycardia cycle length. How would you ensure ventricular capture?
• When pacing near the reentrant circuit for entrainment mapping, a PPI equal to TCL is an observation of what?
• Using a unipolar EGM, a signal with the absence of an R wave and a steep negative deflection indicates the catheter tip (anode) is likely over the signal origin.
• Which parameter describes the amplifier's ability to magnify signal amplitude in electrophysiology equipment?
• In entrainment mapping, a pacing result with no fusion and a PPI equal to TCL indicates:
• Common anatomical locations for right atrial tachycardias include which of the following?
• Which chamber receives oxygenated blood from the lungs?
• In ischemic VT ablation, the target is best described as which of the following?
• If the electrical wavefront is moving toward a positive lead, the electrogram is negative.
• Measured activity between two electrode pairs is referred to as
• Which structures are in the immediate vicinity of the interatrial septum?
• A positive deflection on a unipolar EGM indicates the wavefront is moving toward which electrode?
• A His bundle catheter is primarily used to observe which of the following?
• Entrainment without fusion is known as what?
• Which factor would have a negative effect during cryoablation?
• During EPS, AH jump is an observation typically associated with which phenomenon?
• SNRT stands for
• Which lead is formed between the right arm and left leg electrodes?
• Which filter characteristic passes signals above a cutoff frequency and attenuates lower frequencies?
• Which drug can be used for pharmacological induction of an arrhythmia?
• During repolarization, the heart muscle relaxes.
• Transesophageal echocardiography is the imaging technique of choice to detect thrombus presence.
• What is the standard paper speed for ECG tracings?
• Criteria to initiate and sustain reentry tachycardia include:
• RF ablation at the posterior left atrial wall poses a risk to which adjacent structure?
• In which view do X-ray beams travel perpendicularly from back to front?
• Which structure is the first in the normal conduction sequence through the His-Purkinje system?
• What is the normal QRS duration?
• Which of the following is true about retrograde left atrial access?
• If an SVT terminates without atrial activation upon cessation of ventricular pacing, the pacing maneuver excludes which tachycardia?
• Which option best describes the function of an EP recording system?
• Which statement about deflections on an ECG is true?
• An activation map showing a focal activation would appear as which analogy?
• Which term describes an amplifier's ability to magnify the amplitude of acquired signals?
• Catheter position, success criteria and endpoints of AVNRT ablation are the same for Cryo and RF.
• To achieve a successful CTI ablation, which type of block must be confirmed?
• During retrograde conduction via the AV node, the VA interval lengthens.
• During pace mapping when VT is non-inducible, pacing is performed during which rhythm?
• Which structure is the typical ablation target for AVNRT?
• To access the left atrium through the retrograde approach, the catheter must pass through the aortic valve followed by the ______.
• What is the function of the signal amplifier?
• Which activation sequence is observed for tachycardia originating from the left lateral pathway?
• Which structure forms the entire anterior wall of the right atrium?
• P-wave morphology can help determine the location of the arrhythmia focus. true or false?
• The pulmonary veins drain into the left atrium.
• Ischemic VT ablation focuses on which location?
• In cryoablation for AVNRT, an AV ratio of 1:4-1:10 is acceptable.
• Which chamber is the main muscular pump that sends blood to the systemic circulation?
• Phrenic nerve palsy is defined as
• Which observation during ventricular pacing would most strongly suggest a bypass tract?
• Transseptal approach utilizes the arterial system to access the left side of the heart.
• What does the QT interval represent?
• Which interval is most directly used to assess AV nodal conduction?
• Activation maps described as a pebble in a pond correspond to which pattern?
• Accessory pathway ablation location is typically at which area?
• Phase 0 in pacemaker cells is slower than Phase 0 in ventricular myocytes.
• During AVNRT, RV pacing entrainment typically yields which response?
• The area of slow conduction in scar-related VT is usually located in which tissue?
• What does SVT stand for?
• During Typical Atrial Flutter, which structure forms the electrical barrier?
• Inferior means which direction?
• What mechanism causes triggered arrhythmias?
• Accelerated phase 4 Na leakage into cardiac cells is associated with which mechanism?
• Which structure follows the His bundle in the normal conduction sequence?
• The QRS complex on an ECG represents which event?
• The EP recording system receives all acquired and filtered signals from which component?
• Compared with the slow pathway, the repolarization time of the fast pathway is:
• The coronary sinus ostium is located on which wall of the right atrium?
• During automatic supraventricular tachycardia, which phase of the action potential is elevated?
• What is the primary goal of cardiac ablation?
• Which structure is located Superior to the coronary sinus ostium?
• Contraction of the right ventricle supplies blood to the rest of the body.
• During EP studies, which anatomical structure can complicate access to the coronary sinus ostium?
• Parasympathetic neurons control which aspect of heart function?
• Which view is used to identify lateral and medial locations?
• In EPS, an echo beat indicates retrograde atrial conduction following a ventricular event.
• Automatic supraventricular tachycardia is characterized by a sudden onset tachycardia and does not have a warm up phase. true or false?
• Which of the following is a normal HV interval value?
• Which technique is used to map reentrant circuits in tachyarrhythmias?
• Vagal responses during PV isolation are
• What is the goal of a diagnostic EP study?
• AVRT tachycardia involves a reentrant circuit using an accessory pathway. which term best describes this?
• Repolarization allows for which of the following?
• Phrenic nerve palsy may persist for up to which time frame before resolution is expected?
• Which structure is NOT a component of the triangle of Koch?
• Pacemaker cells have a resting potential that is the same as ventricular myocytes. true or false?
• Bidirectional block confirmation is specifically important for which ablation procedure?
• When mapping a bypass tract, the location of the pathway is inferred by identifying which chamber activation timing?
• A patient becomes hemodynamically unstable after VT induction during EPS. Which mapping techniques can help identify the site of origin while the patient is in sinus rhythm?
• Tachycardias that originate within the atria or above the ventricles are referred to as
• Which structures are innervated by both the parasympathetic and sympathetic nervous systems?
• During AV Wenckebach the PR interval prolongs before a dropped ventricular beat.
• Which of the following drugs are listed as used during intubation?
• If the VT is non-inducible, pace mapping can be used during sinus rhythm to map.
• The narrow band of muscle tissue between the inferior vena cava and the tricuspid valve is called what?
• What chamber receives oxygenated blood from the pulmonary veins?
• In a patient with AVNRT, a His-refractory PVC will affect the tachycardia cycle length.
• Which chamber collects deoxygenated blood from IVC/SVC?
• Phase 0 in pacemaker cells occurs faster than Phase 0 in cardiac cells.
• In anatomical terminology, what does the term posterior mean?
• Which chamber houses the crista terminalis?
• Pacemaker cells consist of which cell types?
• In RF ablation, power control mode delivers RF energy (W) to achieve a set temperature (°C).
• The coronary sinus ostium is located on which wall of the right atrium?
• Orthodromic AVRT has what kind of QRS?
• Anterior means which direction?
• The peri-infarct tissue is characterized by slow conduction contributing to scar-related VT. True or False?
• What is the site of the principal delay in conduction from the SA node to the ventricular myocardium?
• A left lateral wall accessory-pathway tachycardia displays which coronary sinus activation pattern during tachycardia?
• Which statement best describes a primary advantage of intracardiac echocardiography for electrophysiology procedures?
• The reported rate of atrioesophageal fistula with Arctic Front Advance cryoballoon is
• Intracardiac echocardiography is characterized by which of the following?
• The QRS complex corresponds to which cardiac event?
• Which statement best describes the process occurring in phase 2 of the cardiac action potential?
• During irrigation, which statement about its effect on energy delivery is NOT accurate?
• Symptoms of patients with AVNRT typically include which of the following?
• Which tachycardia mechanism involves spontaneous depolarization during the resting potential?
• The ablation target for AVRT involving an accessory pathway is most appropriately described as which of the following?
• During RF energy delivery, irrigated tip catheters provide several benefits except which of the following?
• Which statement best describes S1 S2?
• Which is the correct full sequence of major conduction structures from atria to ventricles?
• What structure can hinder access to the coronary sinus ostium during EP catheterization?
• If the post-pacing interval equals the tachycardia cycle length, what does this indicate about the pacing site?
• In pace mapping, the 12-lead ECG during pacing is compared to which reference?
• Innermost layer of the heart lining the chambers?
• Which item is NOT listed as affecting signal quality and noise?
• What is the main difference between voltage mapping and activation mapping?
• In a healthy individual, the pericardial sac contains between how many milliliters of fluid?
• Which pacing protocol is used in diagnostic SVT studies?
• Which mechanism can provoke the most immediate cell death?
• In entrainment mapping of a flutter circuit, PPI minus TCL should be within how many milliseconds?
• In automatic tachycardia, phase 4 elevation indicates increased automaticity. which statement is true?
• Depolarization refers to which of the following?
• What is the rationale for pacing in the SVC while ablating the right-sided (septal) pulmonary veins?
• Adrenergic receptors bind to which neurotransmitter to cause sympathetic activation?
• Which statement is true regarding integrating intracardiac imaging with 3D mapping systems?
• In a patient that has two pathways connected proximally and distally, with different conduction velocities but the same refractory period, would it be easy to induce reentrant tachycardia?
• In the view where beams travel from back to front, which view is that?
• Which filter passes frequencies higher than the programmed frequency while blocking lower frequencies?
• Which condition can lead to failure to capture tissue during pacing?
• What type of pacing stimulus is used to determine VERP?
• Which term describes the restoration of the resting membrane potential after depolarization?
• Lateral means which direction?
• Cardioversion is the delivery of energy that is
• When pacing near a reentrant circuit for entrainment mapping, PPI = TCL indicates?
• The phrenic nerve runs posterior to the right pulmonary veins.
• The activation pattern in the coronary sinus electrodes during normal sinus rhythm is called what?
• Which radiographic view is used to assess anterior and posterior positions?
• P-wave morphology can be used to localize the origin of an arrhythmia. which choice best reflects this utility?
• VAERP measurement is defined as the longest premature coupling interval that fails to conduct retrogradely to the atrium.
• Which of the following cannot be visualized using transesophageal echocardiography and intracardiac echocardiography during electrophysiology procedures?
• Which structure is located near the posterior wall of the left atrium and can be easily damaged with RF energy?
• Which safety measure is explicitly recommended for industry allied health professionals during EP lab procedures?
• Which of the following is a normal AH interval value?
• Which statement is true regarding esophageal protection during ablation?
• Which lead is formed between the right arm and left leg, with the right arm as the negative electrode and the left leg as the positive electrode?
• Which option best describes the factors that will likely have a positive effect on lesion formation during cryoablation?
• What is a defining feature of narrow complex tachycardia in terms of QRS duration?
• A wide QRS complex is seen in which conditions?
• How is the PR interval defined?
• In anatomical terminology, what does the term superior mean?
• Most ventricular tachycardias occur due to a prior episode of which condition?
• The phase 0 in cardiac muscle cells is caused due to the opening of fast ___________ channels
• Which structure is located posterior to the tricuspid valve?
• Which of these methods can be used to mitigate damage during ablation to the esophagus?
• For AVNRT to occur, a patient must have dual nodal physiology, i.e., slow and fast pathway of AVN. True/False?
• The lead most commonly used to assess BBB morphology is which lead?
• The corrected SNRT (CSNRT) value is derived by calculating
• Which rhythm has a circuit that goes from the atrium through the AV node to the ventricles and returns to the atrium via an accessory pathway?
• What is the principle observation for determining VAERP?
• Which region is defined as the narrow strip of myocardium between the inferior vena cava inlet and the tricuspid valve?
• During a cryoablation procedure, paralytics should only be given for induction.
• RF lesion size formation is influenced by which of the following factors?
• Focal tachycardia can originate from enhanced automaticity or triggered activity. which option correctly reflects this?
• Phases 1 & 2 are absent in the action potential of a ____________ cell.
• The optimal placement of the grounding pad for the RF catheter is
• Chest/precordial leads view the heart's electrical activity on which plane?
• What is the expected outcome of successful ablation of a focal arrhythmia?
• Reentrant circuits do not require two separate pathways with different refractory periods or conduction velocities. true or false?
• Early after-depolarizations occur after the cardiac cells have repolarized.
• Which imaging modality is commonly described as a marker for tissue fibrosis and structural remodeling?
• In retrograde access to the left atrium, which valve must be crossed first?
• The RAO radiographic view is used to assess which positional relationship?
• Which layer forms the outer surface of the heart?
• Which of the following is not a factor that influences RF lesion size?
• AH interval prolongs with decreasing S1-S2 coupling intervals because decreased conduction down the AVN.
• The appearance of the P wave on an ECG reflects which electrical event?