RCES

Question 1

What post ablation finding in a pt with right femoral artery access should be reported to the MD immediately?

Answer 1

access site bruising, no hematoma noted

Question 2

What is the axis of the 12-lead in the image?

Answer 2

LAD

Question 3

What is the anatomical structure in front of the inferior vena cava?

Answer 3

Eustachian ridge

Question 4

During transseptal puncture, what is the scale used to monitor atrial pressure?

Answer 4

25 mmHg

Question 5

Tall peaked T-waves on a 12-lead ECG is associated with

Answer 5

Hyperkalemia

Question 6

After connecting the catheter to the cable, the recording system is not displaying any information from one of the bipole channels. What is the FIRST troubleshooting step to take?

Answer 6

disconnect and reconnect the cable

Question 7

When preparing to transport a patient for a cardiac device implant, what documents must be updated and reviewed? Choose two documents.

Answer 7

H&P
Signed patient consent

Question 8

During open-irrigated ablation, what should be done if the pump alarms?

Answer 8

Stop ablation, notify physician

Question 9

Prior to the patient being put on the table for a device implant, the procedural staff MUST

Answer 9

verify the physician has marked the chest site.

Question 10

Which modality, in addition to fluoroscopy, is MOST FREQUENTLY used to identify anatomical landmarks prior to transseptal puncture?

Answer 10

intracardiac echo

Question 11

Prior to placing a left ventricular pacing lead, what should be performed?

Answer 11

Coronary sinus venogram

Question 12

What disease states could be impacted by occlusion of the left atrial appendage? Choose three risk factors.

Answer 12

-hypertension
-atrial arrhythmias
-transient ischemic attacks

Question 13

Which of the following are Class I indications for CRT implantation? Choose three that apply.

Answer 13

-LEF ≤35%

-QRS ≥120 ms ec

-NYHA class III HF

Question 14

A biohazard bag should be used to dispose of

Answer 14

items saturated with blood or body fluids.

Question 15

Which of the following medications is COMMONLY administered to facilitate induction of AVNRT?

Answer 15

ISO

Question 16

What is the MOST IMPORTANT practice for the placement of chemical indicators in wrapped instrument trays to ensure proper sterilization?

Answer 16

placing chemical indicators in the geometric center of the wrapped tray

Question 17

The PRIMARY SOURCE of airborne bacteria in the procedural area is

Answer 17

The healthcare team

Question 18

During fluoroscopy, the blank
exits the patient to create a radiographic image.

Answer 18

Remnant beam

Question 19

What is the MOST IMPORTANT consideration when selecting a site for a peripheral IV in a patient undergoing a device implant?

Answer 19

Planned side of implant

Question 20

While V pacing just faster than the SVT rate, an A-H-V response is noted upon pacing termination. The SVT MOST LIKELY is

Answer 20

AVNRT

Question 21

What are electrical properties of the cardiac cell? Choose three properties.

Answer 21

automaticity, excitability, and conductivity

Question 22

According to the Vaughn-Williams Classification of Antiarrhythmic Drugs, which antiarrhythm is classified as pure class 3

Answer 22

ibutilide

Question 23

The mA of the stimulator is conventionally set at

Answer 23

2x diastolic threshold

Question 24

Which of the following blood test is MOST LIKELY to be performed prior to removing an arterial sheath in a heparinized patient

Answer 24

ACT

Question 25

What access is obtained when implanting an endocardial left atrial appendage occlusion device?

Answer 25

Transeptal

Question 26

Circulation distal to the femoral artery is BEST assessed by —_ pulses.

Answer 26

Dorsalis-pedis

Question 27

What could a significant drop in impedance mean during a follow-up visit post pacemaker implant?

Answer 27

possible lead dislodgement possible lead insulation breach

Question 28

A left-handed patient presents to the lab for a CIED implantation. What site SHOULD be considered for implantation?

Answer 28

Right pectoral

Question 29

What is the BEST method to distinguish a vein from an artery during femoral ultrasound visualization?

Answer 29

vein will compress more easily with mechanical pressure from the probe

Question 30

What does a bipolar fractionated and low amplitude cardiac signal represent?

Answer 30

myocardial scar or slow conduction

Question 31

Which cardiac chamber does this three dimensional electroanatomical map represent? **picture of PVI

Answer 31

Left atrium

Question 32

Post ICD implant, patients are instructed that they may drive a car after

Answer 32

their physician advises them.

Question 33

His bundle disease is indicated by prolongation of the

Answer 33

H-V interval

Question 34

During monitoring of RF ablation delivery, the catheter temperature reaches 80° Celsius. What is the next action?

Answer 34

Stop the ablation due to potential of coagulum.

Question 35

What is the PRIMARY purpose of carotid massage?

Answer 35

Induce sinus Brady

Question 36

What 12-lead ECG findings are COMMONLY associated with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)? Choose two findings.

Answer 36

Epsilon waves T-wave inversion

Question 37

For effective defibrillation in a patient with an implanted S-ICD, which pad placement strategy is recommended?

Answer 37

Place the pads in an anterolateral position, ensuring they are at least 1-2 inches away from the S-ICD device.

Question 38

A delta wave is the result of

Answer 38

antegrade AP conduction pre-exciting the ventricular tissue.

Question 39

What is the location of the AV node?

Answer 39

RA, at the apex of the triangle of Koch

Question 40

Why is a special air filtration system necessary in an electrophysiology (EP) lab room?

Answer 40

maintain a sterile environment and reduce the risk of infection

Question 41

What is the MAXIMUM diameter for coronary sinus pacemaker leads?

Answer 41

0.035

Question 42

Best practice indicates that the sterile field back table, with liquids, should be prepared

Answer 42

immediately prior to the procedure.

Question 43

When the fluoroscopy C-arm is rotated +30-60° in the left anterior oblique (LAO) position, what is BEST visualized? Choose two that apply.

Answer 43

-differentiation of the atria from ventricles -clock face view of tricuspid and mitral valves

Question 44

When pacing from the proximal CS and measuring lateral to the cavotricuspid isthmus, what stim-A activation time would LIKELY indicate successful ablation of typical atrial flutter?

Answer 44

150ms

Question 45

What are the Class I recommendations for the extraction of chronic pacing and defibrillation leads?

Answer 45

-life-threatening arrhythmias due to a retained lead fragment -a documented infection of the heart, the pacing system, or the pacemaker pocket

Question 46

When handling sterile items, it is important to

Answer 46

Keep them within the sterile field

Question 47

Prior to transferring a patient from the table to a bed, EP staff must

Answer 47

evaluate for adequate staff/equipment to move patient.

Question 48

Which of the following tests should be ordered after venous subclavian puncture?

Answer 48

chest X-ray

Question 49

Which of the following vital signs require IMMEDIATE attention for a patient in the recovery room post VT ablation?

Answer 49

Heart rate of 120 bpm

Question 50

After correctly positioning the transseptal sheath for a transseptal puncture into the left atrium, which fluoroscopic position is ideal for viewing the interatrial septum?

Answer 50

LAO

Question 51

While advancing the RV catheter, the patient suddenly goes into complete heart block. What would be the MOST LIKELY explanation for this occurrence?

Answer 51

Pt has existing LBBB

Question 52

When connecting IV fluid to a venous sheath, the NEXT step is to

Answer 52

Prime tubing and Connect wet to wet

Question 53

Relative to the coronary sinus, the IVC lies

Answer 53

Inferior medial

Question 54

What should be done with used needles?

Answer 54

Placed directly into sharps

Question 55

During tachycardia the VA time is 180 msec. The patient develops LBBB and the VA time increase to 220 msec. What is the MOST LIKELY finding?

Answer 55

A left sided AP

Question 56

Which is true of hypoventilation?

Answer 56

causes pCO2 to increase

Question 57

During an electroanatomical mapping procedure, the system gives a patient movement warning. What is the BEST recommended next step by the manufacturer?

Answer 57

Start a new map

Question 58

What is a CRITICAL monitoring method to detect respiratory depression during moderate sedation?

Answer 58

end-tidal CO2 monitoring via capnography

Question 59

Lead conductor fracture typically results in

Answer 59

High impedance

Question 60

Post PVI, the patient vitals indicate tachycardia and hypotension. What is the potential complication?

Answer 60

Cardiac tamponade

Question 61

Defibrillation threshold testing (DFT) may be performed in which of the -following circumstances? Select three .

Answer 61

-failed therapy delivery. -congestive heart -initiation of amiodarone therapy

Question 62

During the patient hand-off, what information reported is DIRECTLY RELATED to the Afib procedure?

Answer 62

Patient ECG showed a normal sinus rhythm throughout the post-procedural monitoring.

Question 63

Repetitive delivery of 8 atrial paced beats at the same cycle length followed by the 9th paced atrial beat which is delivered with a shorter coupling interval describes which of the following pacing protocols?

Answer 63

atrial extrastimuli.

Question 64

Assuming normal anatomy and proper positioning of the CS catheter, which C-arm angle displays the CS catheter pointing towards the 3 o'clock position?

Answer 64

LAO

Question 65

What is retrograde conduction?

Answer 65

conduction from the ventricle to the atrium

Question 66

What is the MOST COMMON site for an idiopathic VT?

Answer 66

RVOT

Question 67

Post-pulmonary vein isolation (PVI), the patient in the holding area experiences sudden emesis, and the left side of the face appears to be flaccid. What is the potential complication presented with this finding?

Answer 67

CVA

Question 68

While ablating near the ostium of coronary sinus, what does a sudden 60 ohm increase in impedance indicate?

Answer 68

ablation catheter has fallen into the coronary sinus

Question 69

What is the MOST COMMON tachycardia mechanism?

Answer 69

Reentry

Question 70

A 300-pound patient is prepared for an ablation and baseline real time impedance is 200 ohms. What is the BEST next step?

Answer 70

Place grounding pad on right lower back

Question 71

During an EP Study, which diagnostic catheter is positioned at the tricuspid annulus?

Answer 71

HIS

Question 72

Which pacing protocols are MOST LIKELY to induce typical atrial flutter? Choose two protocols.

Answer 72

programmed electrical stimulation from the lateral RA programmed electrical stimulation from the proximal CS

Question 73

Which tachycardia mechanism requires the following prerequisites? * Two pathways (A&B) must be connected. * One pathway must conduct more slowly. * The pathways must have different recovery times.

Answer 73

Reentry

Question 74

The patient complains of itching and feeling warm within 15 minutes post IVAncef infusion. What IMMEDIATE action should be taken?

Answer 74

stop the Ancef infusion and notify the physician

Question 75

A SPECIFIC complication associated with pulmonary vein isolation

Answer 75

atrioesophageal fistula.

Question 76

Which are appropriate high/low pass filters for intracardiac electrograms in Hertz (Hz)?

Answer 76

30/500

Question 77

What is the intended result of moving the ground patch closer to the site of RF energy?

Answer 77

Decrease in impedance

Question 78

During RF of an AV nodal slow pathway, there is loss of retrograde atrial conduction. What is the appropriate response?

Answer 78

Stop RF application

Question 79

What medical term indicates 'towards the feet?

Answer 79

Caudal

Question 80

Which medication prolongs the action potential duration and refractoriness?

Answer 80

Amiodarone

Question 81

The TEE results, to rule out atrial appendage thrombus, have not been received prior to the patient transfer to the procedure lab. What should be done?

Answer 81

The result should be obtained before proceeding.

Question 82

What is an acceptable K+ level for a patient undergoing an EP study?

Answer 82

4.3 Range is 3.5-5

Question 83

When removing venous sheaths, manual pressure should be held

Answer 83

Just above the puncture site

Question 84

A patient with a history of WW presents to the ER in this rhythm. Which drug is the MOST APPROPRIATE?

Answer 84

Amiodarone

Question 85

What temporary pacemaker adjustment would change the unit from the demand mode to the asynchronous mode?.

Answer 85

Decrease sensitivity

Question 86

Focal arrhythmias are typically characterized by presystolic activation timings of a minimum of msec.

Answer 86

30

Question 87

In an effective RF burn, the impedance should

Answer 87

increase initially, then decrease and stabilize.

Question 88

What can cardiac signals displaying low and wide signal amplitude be described as?

Answer 88

Far field

Question 89

According to the Vaughn-Williams Classification of Antiarrhythmic Drugs, which antiarrhythmic is classified as pure class III?

Answer 89

ibutilide

Question 90

At the time of device implant, the atrial sensing threshold in sinus rhythm should be at least mv.

Answer 90

1.0

Question 91

With ventricular pacing, the activation sequence of a left lateral pathway is characterized by

Answer 91

distal CS A first.

Question 92

Which ventricular tachycardias (VT) are often provoked with exercise? Choose three tachycardias.

Answer 92

VT associated with ARVC VT associated with LQTS 2 right ventricular outflow tract VT