CCDS IBHRE LATEST 2026 EXAM QUESTIONS AND
SOLUTIONS RATED A+
✔✔minimal pacing rate on VDD mode - ✔✔base interval in ms plus PV interval divided
by 60000
✔✔VDD pacing - using unipolar lead, bipolar lead(wide spacing and narrow spacing),
and orthogonal - ✔✔Unipolar - oversensing extraneous signals such as myopotentials
Bipolar - eliminates the likelihood for myopotential oversensing, the wide spacing has
the lowest and widest signal deflection while the narrow spacing has the highest and
fastest deflection
Orthogonal - half rings located directly opposite each other on the lead body with
electrically opposite plate
✔✔indication of VDD pacing - ✔✔complete heart block without evidence of chronotropic
incompetence, sinus node disease, retrograde conduction, or atrial arrhythmias
✔✔Brugada syndrome - ✔✔1. right bundle branch block
2. ST elevation in V1 to V3
3. morphology of the QRS complex resembling J point elevation
4. related to sudden death
5. structurally normal heart
6. based on phase 2 of the action potential retry due to Na channel involvement
✔✔Brugada syndrome presentation - ✔✔1. syncope and sudden death caused by fast,
POLYMORPHIC ventricular tachycardia or ventricular fibrillation
2. no warning
3. no prolongation of the QT interval during sinus rhythm
4. only in very few cases there is alternation of long-short sequences before the
polymorphic VT
5. no preceding acceleration in the heart rate as the case of catecholamine-dependent
polymorphic VT
✔✔Brugada syndrome EP findings - ✔✔1. majority of the patients with normal sinus
node
2. 10% with afib
3. inducibility of VF - easily induced by 1 or 2 ventricular pacing, or 3.
4. sustained VF, cause hemodynamic collapse, and requires external DC
5. HV interval is prolonged in about half of the patients, but rarely exceeding 70ms
✔✔Drugs that are primarily eliminated by liver - ✔✔- quinidine
- mexiletine
- propafenone
- verapamil
- procainamide
,- flecainide
- moricizine
- diltiazem
- lidocaine
- encainide
- amiodarone
✔✔Drugs that are primarily eliminated by kidneys - ✔✔- disopyramide
- tocainide
- bretylium
- sotalol
- digoxin
✔✔AAD eliminates through the vascular endothelium, erythrocytes - ✔✔adenosine
✔✔drugs that increase the digoxin level - ✔✔- quinidine
- flecainide
- propafenone
- amiodarone
- verapamil
✔✔lidocaine and beta blockers - ✔✔beta blocker increases lidocaine level
✔✔medications use with beta blocker cause additive inotropic effects - ✔✔-
disopyramide
- flecainide
✔✔medications that use with beta blocker cause increase beta blocking effect - ✔✔-
amiodarone
- propafenone
✔✔medications that use with calcium channel blockers cause additive inotropic effect -
✔✔- flecainide
- propafenone
- disopyramide
✔✔type IA antiarrhythmic drugs - ✔✔- quinidine
- procainamide
- disopyramide
✔✔type IB antiarrhythmic drugs - ✔✔- lidocaine
- mexiletine
✔✔type IC antiarrhythmic drugs - ✔✔- flecainide
- propafenone
, - moricizine
✔✔type II antiarrhythmic drugs - ✔✔beta blockers
✔✔type III antiarrhythmic drugs - ✔✔- amiodarone
- bretylium
- dofetilide
- ibutilide
- sotalol
✔✔type IV antiarrhythmic drugs - ✔✔- calcium channel blockers
- verapamil
- diltiazem
✔✔drugs that increase DFT threshold - ✔✔- lidocaine
- diphenlhydantoin
- quinidine
- flecainide
✔✔impedance - ✔✔numerical sum of all resistances to the flow of electrons
✔✔unit of current - ✔✔ampere
1 amp = 1 coulomb/sec = 1000 milliamps = 1,000,000 microamps
✔✔capacitance - ✔✔relationship between charge stored and voltage applied
Stored energy: E(joules) = 0.5*C*V2
Delivered energy: E(joules)*C*(Vinitial2 - Vfinal2)
✔✔energy - ✔✔a measure of power expended over time
power - the rate at which energy is delivered or absorbed
1 joule = 1 watt
E=VxIxT
E = V x I x PW
E = V2/R x PW
E = I2 x R x PW
If current (I) is in mA and time in msec then answer will be in mjolues
✔✔slew rate - ✔✔measurement of voltage change over time
dV/dt
used for measuring intrinsic beats
atrium = >0.5 vS
ventricle = >0.75 vS
✔✔total atrial refractory period(TARP) - ✔✔sum of PV interval plus atrial refractory
period
SOLUTIONS RATED A+
✔✔minimal pacing rate on VDD mode - ✔✔base interval in ms plus PV interval divided
by 60000
✔✔VDD pacing - using unipolar lead, bipolar lead(wide spacing and narrow spacing),
and orthogonal - ✔✔Unipolar - oversensing extraneous signals such as myopotentials
Bipolar - eliminates the likelihood for myopotential oversensing, the wide spacing has
the lowest and widest signal deflection while the narrow spacing has the highest and
fastest deflection
Orthogonal - half rings located directly opposite each other on the lead body with
electrically opposite plate
✔✔indication of VDD pacing - ✔✔complete heart block without evidence of chronotropic
incompetence, sinus node disease, retrograde conduction, or atrial arrhythmias
✔✔Brugada syndrome - ✔✔1. right bundle branch block
2. ST elevation in V1 to V3
3. morphology of the QRS complex resembling J point elevation
4. related to sudden death
5. structurally normal heart
6. based on phase 2 of the action potential retry due to Na channel involvement
✔✔Brugada syndrome presentation - ✔✔1. syncope and sudden death caused by fast,
POLYMORPHIC ventricular tachycardia or ventricular fibrillation
2. no warning
3. no prolongation of the QT interval during sinus rhythm
4. only in very few cases there is alternation of long-short sequences before the
polymorphic VT
5. no preceding acceleration in the heart rate as the case of catecholamine-dependent
polymorphic VT
✔✔Brugada syndrome EP findings - ✔✔1. majority of the patients with normal sinus
node
2. 10% with afib
3. inducibility of VF - easily induced by 1 or 2 ventricular pacing, or 3.
4. sustained VF, cause hemodynamic collapse, and requires external DC
5. HV interval is prolonged in about half of the patients, but rarely exceeding 70ms
✔✔Drugs that are primarily eliminated by liver - ✔✔- quinidine
- mexiletine
- propafenone
- verapamil
- procainamide
,- flecainide
- moricizine
- diltiazem
- lidocaine
- encainide
- amiodarone
✔✔Drugs that are primarily eliminated by kidneys - ✔✔- disopyramide
- tocainide
- bretylium
- sotalol
- digoxin
✔✔AAD eliminates through the vascular endothelium, erythrocytes - ✔✔adenosine
✔✔drugs that increase the digoxin level - ✔✔- quinidine
- flecainide
- propafenone
- amiodarone
- verapamil
✔✔lidocaine and beta blockers - ✔✔beta blocker increases lidocaine level
✔✔medications use with beta blocker cause additive inotropic effects - ✔✔-
disopyramide
- flecainide
✔✔medications that use with beta blocker cause increase beta blocking effect - ✔✔-
amiodarone
- propafenone
✔✔medications that use with calcium channel blockers cause additive inotropic effect -
✔✔- flecainide
- propafenone
- disopyramide
✔✔type IA antiarrhythmic drugs - ✔✔- quinidine
- procainamide
- disopyramide
✔✔type IB antiarrhythmic drugs - ✔✔- lidocaine
- mexiletine
✔✔type IC antiarrhythmic drugs - ✔✔- flecainide
- propafenone
, - moricizine
✔✔type II antiarrhythmic drugs - ✔✔beta blockers
✔✔type III antiarrhythmic drugs - ✔✔- amiodarone
- bretylium
- dofetilide
- ibutilide
- sotalol
✔✔type IV antiarrhythmic drugs - ✔✔- calcium channel blockers
- verapamil
- diltiazem
✔✔drugs that increase DFT threshold - ✔✔- lidocaine
- diphenlhydantoin
- quinidine
- flecainide
✔✔impedance - ✔✔numerical sum of all resistances to the flow of electrons
✔✔unit of current - ✔✔ampere
1 amp = 1 coulomb/sec = 1000 milliamps = 1,000,000 microamps
✔✔capacitance - ✔✔relationship between charge stored and voltage applied
Stored energy: E(joules) = 0.5*C*V2
Delivered energy: E(joules)*C*(Vinitial2 - Vfinal2)
✔✔energy - ✔✔a measure of power expended over time
power - the rate at which energy is delivered or absorbed
1 joule = 1 watt
E=VxIxT
E = V x I x PW
E = V2/R x PW
E = I2 x R x PW
If current (I) is in mA and time in msec then answer will be in mjolues
✔✔slew rate - ✔✔measurement of voltage change over time
dV/dt
used for measuring intrinsic beats
atrium = >0.5 vS
ventricle = >0.75 vS
✔✔total atrial refractory period(TARP) - ✔✔sum of PV interval plus atrial refractory
period
