IBHRE CEPS-P Exam Study Set — 2026/2027
IBHRE CERTIFIED ELECTROPHYSIOLOGY SPECIALIST–PEDIATRIC (CEPS-P) EXAM
STUDY SET
2026/2027 | 175 Questions | Physician-Level Exam Prep
Based on the International Board of Heart Rhythm Examiners (IBHRE) CEPS-P Examination Blueprint
Instructions: Select the best answer for each question. SATA items require selecting all correct responses.
Ordered items require placing steps in the correct sequence. Answers and rationales follow each question.
SECTION I: PEDIATRIC CARDIAC ANATOMY & ELECTROPHYSIOLOGY (Q1–30)
1. During normal cardiac embryogenesis, the atrioventricular (AV) canal is divided into right
and left AV orifices by which structure?
A. Endocardial cushions
B. Bulbus cordis
C. Septum primum
D. Truncus arteriosus
Correct Answer: A. Endocardial cushions
Rationale: The endocardial cushions are mesenchymal tissue masses that develop at the AV canal and
contribute to formation of the mitral and tricuspid valve annuli, the AV septum, and the membranous
portion of the ventricular septum. Failure of endocardial cushion fusion results in complete AV septal defect
(AVSD), commonly seen in trisomy 21. The bulbus cordis (B) gives rise to the right ventricle and outflow
tracts. The septum primum (C) is the first atrial septum. The truncus arteriosus (D) gives rise to the aorta
and pulmonary artery.
2. A 14-year-old patient with repaired tetralogy of Fallot (TOF) presents for EP evaluation.
Which anatomic feature of TOF is MOST relevant to the development of ventricular
arrhythmias post-repair?
A. Overriding aorta
B. Right ventricular outflow tract (RVOT) infundibular stenosis
C. Ventricular septal defect (VSD)
D. Right ventricular hypertrophy with surgical scar
Correct Answer: D. Right ventricular hypertrophy with surgical scar
Rationale: Sustained ventricular tachycardia (VT) in repaired TOF is most commonly caused by reentry
around the RVOT surgical scar and patch. The right ventricular hypertrophy (RVH) component of TOF is
exacerbated by chronic pressure overload and creates substrate for reentry after repair. QRS duration
>180 ms on ECG correlates with increased risk of malignant VT. While RVOT stenosis (B) and VSD (C) are
components of TOF, the scar-related reentry circuit is the primary arrhythmia mechanism. The overriding
aorta (A) does not contribute to arrhythmogenesis.
3. In a patient with D-transposition of the great arteries (D-TGA) who underwent a Mustard
atrial baffle repair, sinus node dysfunction occurs in approximately what percentage of long-
term survivors?
A. 5–10%
B. 20–30%
C. 40–60%
D. >80%
Correct Answer: C. 40–60%
Rationale: Sinus node dysfunction (SND) is extremely common after Mustard and Senning atrial baffle
procedures for D-TGA, occurring in 40–60% of long-term survivors. The Mustard procedure involves
extensive atrial septal surgery that can damage the sinus node or its arterial supply. SND may manifest as
chronotropic incompetence, sinus bradycardia, or junctional rhythm. Atrial arrhythmias, particularly
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, IBHRE CEPS-P Exam Study Set — 2026/2027
intra-atrial reentrant tachycardia (IART), are also common and contribute to significant morbidity. Many
patients eventually require permanent pacing. The arterial switch operation (ASO) has largely replaced
atrial baffle procedures, avoiding these long-term atrial complications.
4. Select all that apply. Which of the following congenital heart defects are associated with an
increased risk of atrial flutter or intra-atrial reentrant tachycardia (IART)? [Select All That
Apply]
A. Fontan circulation
B. Mustard/Senning repair for D-TGA
C. Secundum atrial septal defect (ASD)
D. Repaired tetralogy of Fallot
E. Hypoplastic left heart syndrome (HLHS) after Fontan
Correct Answer: A. Fontan circulation, B. Mustard/Senning repair for D-TGA, D. Repaired
tetralogy of Fallot, E. Hypoplastic left heart syndrome (HLHS) after Fontan
Rationale: IART and atrial flutter are common late complications in patients with CHD involving atrial
dilation, atrial scarring from surgery, or elevated atrial pressures. Fontan patients (A, E) have massive
right atrial enlargement and elevated systemic venous pressures, creating a strong substrate for IART.
Mustard/Senning patients (B) have extensive atrial baffles with suture lines that serve as anchors for
reentry. Repaired TOF (D) patients may develop atrial tachyarrhythmias, though ventricular arrhythmias
are more characteristic. Small unrepaired secundum ASDs (C) rarely cause atrial flutter unless significant
atrial dilation is present.
5. What is the normal sinus heart rate range for a healthy 3-year-old child at rest?
A. 60–80 bpm
B. 80–120 bpm
C. 100–160 bpm
D. 120–180 bpm
Correct Answer: B. 80–120 bpm
Rationale: The normal resting heart rate for children varies by age. For a 3-year-old, the normal sinus
rate is 80–120 bpm. Neonates have the highest normal rates (120–160 bpm, C). Infants 1–12 months have
rates of 100–150 bpm. School-age children (6–12 years) have rates of 70–110 bpm. Adolescents and adults
have rates of 60–100 bpm (A). Understanding age-specific heart rate norms is essential for pediatric EP
practice, as what constitutes tachycardia or bradycardia varies significantly with age.
6. The PR interval on a standard 12-lead ECG represents which electrophysiological event?
A. QRS depolarization of the ventricles
B. Atrial depolarization and AV conduction time
C. Ventricular repolarization
D. SA node recovery time
Correct Answer: B. Atrial depolarization and AV conduction time
Rationale: The PR interval measures the time from the onset of atrial depolarization (P wave) to the onset
of ventricular depolarization (Q wave or R wave). It primarily reflects AV conduction through the AV node
and His-Purkinje system. The normal PR interval in children varies with age: neonates 80–120 ms,
children 100–200 ms. Prolonged PR interval (>200 ms in older children and adults) indicates first-degree
AV block. The QRS duration (A) represents ventricular depolarization time. The QT interval encompasses
ventricular depolarization and repolarization (C). SA node recovery time (D) is an invasive EP study
measurement.
7. Ebstein anomaly is characterized by apical displacement of the tricuspid valve leaflets.
Which electrophysiological abnormality is MOST characteristically associated with Ebstein
anomaly?
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, IBHRE CEPS-P Exam Study Set — 2026/2027
A. Ventricular tachycardia
B. Atrioventricular reentrant tachycardia (AVRT) via accessory pathways
C. Complete heart block
D. Atrial standstill
Correct Answer: B. Atrioventricular reentrant tachycardia (AVRT) via accessory pathways
Rationale: Ebstein anomaly is strongly associated with accessory pathways (APs), present in up to 25–
30% of patients. These APs are often right-sided and may have multiple pathways. APs in Ebstein anomaly
have a higher prevalence of antegrade conduction compared to typical Wolff-Parkinson-White (WPW) in
structurally normal hearts, which increases the risk of pre-excited atrial fibrillation. AVRT via these
pathways is the most common sustained tachyarrhythmia. Complete heart block (C) is rare. Atrial
tachyarrhythmias may also occur due to atrial enlargement but AVRT (B) is most characteristic.
8. A 10-year-old boy with Fontan completion for tricuspid atresia presents with palpitations
and fatigue. ECG shows a regular narrow-complex tachycardia at 180 bpm with discrete P
waves preceding each QRS. The P-wave axis is abnormal. Which tachycardia is MOST likely?
A. Orthodromic AVRT
B. Typical AV node reentrant tachycardia (AVNRT)
C. Intra-atrial reentrant tachycardia (IART)
D. Atrial fibrillation
Correct Answer: C. Intra-atrial reentrant tachycardia (IART)
Rationale: In a Fontan patient, IART (also called atrial flutter) is the most common sustained
arrhythmia. The hallmark features include a regular narrow-complex tachycardia with discrete P waves
that are clearly different from sinus P waves (abnormal axis/morphology). AVNRT (B) is uncommon in
children, particularly those with CHD. AVRT (A) is less common than IART in this population. Atrial
fibrillation (D) is rare in children. IART circuits in Fontan patients often involve the right atrial
scar/atriotomy incision, the cavotricuspid isthmus, or the lateral atrial wall. Diagnosis requires high
clinical suspicion as symptoms may be subtle due to limited cardiac output in Fontan physiology.
9. In a healthy neonate, the dominant autonomic nervous system influence on heart rate is
mediated primarily through which mechanism?
A. Increased sympathetic tone
B. Vagal (parasympathetic) predominance
C. Balanced sympathetic and parasympathetic tone
D. Alpha-adrenergic receptor dominance
Correct Answer: B. Vagal (parasympathetic) predominance
Rationale: Neonates and infants have predominant vagal (parasympathetic) tone, which explains the
high prevalence of sinus arrhythmia, sinus bradycardia, and AV block (first or second degree) in this age
group. Sinus arrhythmia, a phasic variation in heart rate with respiration, is a normal finding in children
and reflects intact vagal tone. Sympathetic tone increases progressively with age, resulting in the gradual
decrease in resting heart rate through childhood into adulthood. This autonomic maturation is important
when evaluating pediatric ECGs and heart rate variability.
10. What is the approximate QRS duration upper limit of normal for a 2-month-old infant?
A. 60 ms
B. 80 ms
C. 100 ms
D. 120 ms
Correct Answer: A. 60 ms
Rationale: The upper limit of normal QRS duration is age-dependent. For neonates and young infants,
the QRS upper limit is approximately 60 ms (0.06 seconds). For children aged 1–4 years, it is
approximately 80 ms. For children 5–11 years, it is approximately 90 ms. For adolescents and adults, it is
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, IBHRE CEPS-P Exam Study Set — 2026/2027
100–120 ms. Prolonged QRS duration in an infant may indicate ventricular hypertrophy, bundle branch
block, or pre-excitation. These age-adjusted norms are critical for interpreting pediatric ECGs, as applying
adult criteria would lead to many false-positive findings.
11. In patients with hypoplastic left heart syndrome (HLHS) after Fontan palliation, which
hemodynamic factor MOST contributes to the high prevalence of atrial arrhythmias?
A. Left ventricular dysfunction
B. Elevated central venous pressure and atrial dilation
C. Pulmonary hypertension
D. Systemic desaturation
Correct Answer: B. Elevated central venous pressure and atrial dilation
Rationale: Fontan physiology is characterized by passive systemic venous return to the pulmonary
arteries without a subpulmonary ventricle. This results in chronically elevated central venous pressure
(CVP) and progressive atrial dilation (particularly the right atrium or Fontan conduit). Elevated CVP,
atrial stretch, atrial fibrosis, and surgical scarring all contribute to the substrate for atrial arrhythmias,
particularly IART. While ventricular dysfunction (A), pulmonary hypertension (C), and desaturation (D)
are important complications, the atrial substrate is the primary driver of arrhythmia in this population.
12. Place the following stages of normal cardiac conduction system development in fetal life in
the correct sequence (1 = earliest, 5 = latest). [Ordered Response]
1. The His-Purkinje system develops and conducts impulses to the ventricles
2. The sinoatrial (SA) node becomes the dominant pacemaker
3. Cardiac impulse initially originates from the primitive ventricle
4. The AV node forms at the AV canal junction
5. Preferential internodal atrial pathways develop for fast AV conduction
Correct Answer: 3 → 4 → 1 → 5 → 2
Rationale: Cardiac conduction system development follows a characteristic sequence. Initially (3), the
primitive tubular heart contracts in a peristaltic fashion with impulses originating from the ventricle. As
the atria and ventricles separate, the AV canal region develops the AV node (4). The His-Purkinje system
then forms (1), allowing coordinated ventricular depolarization. Internodal pathways develop later (5),
facilitating rapid atrial-to-ventricular conduction. The SA node assumes dominance last (2), typically by
the end of the first trimester. Before SA node maturation, the AV node or lower atrial tissue may serve as
the dominant pacemaker, which explains some fetal and neonatal arrhythmia patterns.
13. A 5-year-old girl with a large secundum ASD presents with intermittent palpitations. ECG
shows a delta wave with a short PR interval. What is the significance of these findings?
A. Isolated WPW syndrome requiring ablation
B. Accessory pathway with antegrade pre-excitation in the setting of ASD
C. Ebstein anomaly with atrial septal defect
D. Lown-Ganong-Levine syndrome
Correct Answer: B. Accessory pathway with antegrade pre-excitation in the setting of ASD
Rationale: The finding of a delta wave and short PR interval indicates ventricular pre-excitation via an
accessory pathway. The coexistence of ASD and WPW can occur together, though the association is less
strong than with Ebstein anomaly. In this patient, the AP should be characterized with EP study,
particularly assessing for antegrade effective refractory period. ASD repair and AP ablation can often be
performed simultaneously. Lown-Ganong-Levine (D) features a short PR without a delta wave. Ebstein
anomaly (C) would typically have tricuspid valve displacement on echocardiography.
14. Which coronary artery anomaly is MOST associated with sudden cardiac death (SCD) in
young athletes?
4
IBHRE CERTIFIED ELECTROPHYSIOLOGY SPECIALIST–PEDIATRIC (CEPS-P) EXAM
STUDY SET
2026/2027 | 175 Questions | Physician-Level Exam Prep
Based on the International Board of Heart Rhythm Examiners (IBHRE) CEPS-P Examination Blueprint
Instructions: Select the best answer for each question. SATA items require selecting all correct responses.
Ordered items require placing steps in the correct sequence. Answers and rationales follow each question.
SECTION I: PEDIATRIC CARDIAC ANATOMY & ELECTROPHYSIOLOGY (Q1–30)
1. During normal cardiac embryogenesis, the atrioventricular (AV) canal is divided into right
and left AV orifices by which structure?
A. Endocardial cushions
B. Bulbus cordis
C. Septum primum
D. Truncus arteriosus
Correct Answer: A. Endocardial cushions
Rationale: The endocardial cushions are mesenchymal tissue masses that develop at the AV canal and
contribute to formation of the mitral and tricuspid valve annuli, the AV septum, and the membranous
portion of the ventricular septum. Failure of endocardial cushion fusion results in complete AV septal defect
(AVSD), commonly seen in trisomy 21. The bulbus cordis (B) gives rise to the right ventricle and outflow
tracts. The septum primum (C) is the first atrial septum. The truncus arteriosus (D) gives rise to the aorta
and pulmonary artery.
2. A 14-year-old patient with repaired tetralogy of Fallot (TOF) presents for EP evaluation.
Which anatomic feature of TOF is MOST relevant to the development of ventricular
arrhythmias post-repair?
A. Overriding aorta
B. Right ventricular outflow tract (RVOT) infundibular stenosis
C. Ventricular septal defect (VSD)
D. Right ventricular hypertrophy with surgical scar
Correct Answer: D. Right ventricular hypertrophy with surgical scar
Rationale: Sustained ventricular tachycardia (VT) in repaired TOF is most commonly caused by reentry
around the RVOT surgical scar and patch. The right ventricular hypertrophy (RVH) component of TOF is
exacerbated by chronic pressure overload and creates substrate for reentry after repair. QRS duration
>180 ms on ECG correlates with increased risk of malignant VT. While RVOT stenosis (B) and VSD (C) are
components of TOF, the scar-related reentry circuit is the primary arrhythmia mechanism. The overriding
aorta (A) does not contribute to arrhythmogenesis.
3. In a patient with D-transposition of the great arteries (D-TGA) who underwent a Mustard
atrial baffle repair, sinus node dysfunction occurs in approximately what percentage of long-
term survivors?
A. 5–10%
B. 20–30%
C. 40–60%
D. >80%
Correct Answer: C. 40–60%
Rationale: Sinus node dysfunction (SND) is extremely common after Mustard and Senning atrial baffle
procedures for D-TGA, occurring in 40–60% of long-term survivors. The Mustard procedure involves
extensive atrial septal surgery that can damage the sinus node or its arterial supply. SND may manifest as
chronotropic incompetence, sinus bradycardia, or junctional rhythm. Atrial arrhythmias, particularly
1
, IBHRE CEPS-P Exam Study Set — 2026/2027
intra-atrial reentrant tachycardia (IART), are also common and contribute to significant morbidity. Many
patients eventually require permanent pacing. The arterial switch operation (ASO) has largely replaced
atrial baffle procedures, avoiding these long-term atrial complications.
4. Select all that apply. Which of the following congenital heart defects are associated with an
increased risk of atrial flutter or intra-atrial reentrant tachycardia (IART)? [Select All That
Apply]
A. Fontan circulation
B. Mustard/Senning repair for D-TGA
C. Secundum atrial septal defect (ASD)
D. Repaired tetralogy of Fallot
E. Hypoplastic left heart syndrome (HLHS) after Fontan
Correct Answer: A. Fontan circulation, B. Mustard/Senning repair for D-TGA, D. Repaired
tetralogy of Fallot, E. Hypoplastic left heart syndrome (HLHS) after Fontan
Rationale: IART and atrial flutter are common late complications in patients with CHD involving atrial
dilation, atrial scarring from surgery, or elevated atrial pressures. Fontan patients (A, E) have massive
right atrial enlargement and elevated systemic venous pressures, creating a strong substrate for IART.
Mustard/Senning patients (B) have extensive atrial baffles with suture lines that serve as anchors for
reentry. Repaired TOF (D) patients may develop atrial tachyarrhythmias, though ventricular arrhythmias
are more characteristic. Small unrepaired secundum ASDs (C) rarely cause atrial flutter unless significant
atrial dilation is present.
5. What is the normal sinus heart rate range for a healthy 3-year-old child at rest?
A. 60–80 bpm
B. 80–120 bpm
C. 100–160 bpm
D. 120–180 bpm
Correct Answer: B. 80–120 bpm
Rationale: The normal resting heart rate for children varies by age. For a 3-year-old, the normal sinus
rate is 80–120 bpm. Neonates have the highest normal rates (120–160 bpm, C). Infants 1–12 months have
rates of 100–150 bpm. School-age children (6–12 years) have rates of 70–110 bpm. Adolescents and adults
have rates of 60–100 bpm (A). Understanding age-specific heart rate norms is essential for pediatric EP
practice, as what constitutes tachycardia or bradycardia varies significantly with age.
6. The PR interval on a standard 12-lead ECG represents which electrophysiological event?
A. QRS depolarization of the ventricles
B. Atrial depolarization and AV conduction time
C. Ventricular repolarization
D. SA node recovery time
Correct Answer: B. Atrial depolarization and AV conduction time
Rationale: The PR interval measures the time from the onset of atrial depolarization (P wave) to the onset
of ventricular depolarization (Q wave or R wave). It primarily reflects AV conduction through the AV node
and His-Purkinje system. The normal PR interval in children varies with age: neonates 80–120 ms,
children 100–200 ms. Prolonged PR interval (>200 ms in older children and adults) indicates first-degree
AV block. The QRS duration (A) represents ventricular depolarization time. The QT interval encompasses
ventricular depolarization and repolarization (C). SA node recovery time (D) is an invasive EP study
measurement.
7. Ebstein anomaly is characterized by apical displacement of the tricuspid valve leaflets.
Which electrophysiological abnormality is MOST characteristically associated with Ebstein
anomaly?
2
, IBHRE CEPS-P Exam Study Set — 2026/2027
A. Ventricular tachycardia
B. Atrioventricular reentrant tachycardia (AVRT) via accessory pathways
C. Complete heart block
D. Atrial standstill
Correct Answer: B. Atrioventricular reentrant tachycardia (AVRT) via accessory pathways
Rationale: Ebstein anomaly is strongly associated with accessory pathways (APs), present in up to 25–
30% of patients. These APs are often right-sided and may have multiple pathways. APs in Ebstein anomaly
have a higher prevalence of antegrade conduction compared to typical Wolff-Parkinson-White (WPW) in
structurally normal hearts, which increases the risk of pre-excited atrial fibrillation. AVRT via these
pathways is the most common sustained tachyarrhythmia. Complete heart block (C) is rare. Atrial
tachyarrhythmias may also occur due to atrial enlargement but AVRT (B) is most characteristic.
8. A 10-year-old boy with Fontan completion for tricuspid atresia presents with palpitations
and fatigue. ECG shows a regular narrow-complex tachycardia at 180 bpm with discrete P
waves preceding each QRS. The P-wave axis is abnormal. Which tachycardia is MOST likely?
A. Orthodromic AVRT
B. Typical AV node reentrant tachycardia (AVNRT)
C. Intra-atrial reentrant tachycardia (IART)
D. Atrial fibrillation
Correct Answer: C. Intra-atrial reentrant tachycardia (IART)
Rationale: In a Fontan patient, IART (also called atrial flutter) is the most common sustained
arrhythmia. The hallmark features include a regular narrow-complex tachycardia with discrete P waves
that are clearly different from sinus P waves (abnormal axis/morphology). AVNRT (B) is uncommon in
children, particularly those with CHD. AVRT (A) is less common than IART in this population. Atrial
fibrillation (D) is rare in children. IART circuits in Fontan patients often involve the right atrial
scar/atriotomy incision, the cavotricuspid isthmus, or the lateral atrial wall. Diagnosis requires high
clinical suspicion as symptoms may be subtle due to limited cardiac output in Fontan physiology.
9. In a healthy neonate, the dominant autonomic nervous system influence on heart rate is
mediated primarily through which mechanism?
A. Increased sympathetic tone
B. Vagal (parasympathetic) predominance
C. Balanced sympathetic and parasympathetic tone
D. Alpha-adrenergic receptor dominance
Correct Answer: B. Vagal (parasympathetic) predominance
Rationale: Neonates and infants have predominant vagal (parasympathetic) tone, which explains the
high prevalence of sinus arrhythmia, sinus bradycardia, and AV block (first or second degree) in this age
group. Sinus arrhythmia, a phasic variation in heart rate with respiration, is a normal finding in children
and reflects intact vagal tone. Sympathetic tone increases progressively with age, resulting in the gradual
decrease in resting heart rate through childhood into adulthood. This autonomic maturation is important
when evaluating pediatric ECGs and heart rate variability.
10. What is the approximate QRS duration upper limit of normal for a 2-month-old infant?
A. 60 ms
B. 80 ms
C. 100 ms
D. 120 ms
Correct Answer: A. 60 ms
Rationale: The upper limit of normal QRS duration is age-dependent. For neonates and young infants,
the QRS upper limit is approximately 60 ms (0.06 seconds). For children aged 1–4 years, it is
approximately 80 ms. For children 5–11 years, it is approximately 90 ms. For adolescents and adults, it is
3
, IBHRE CEPS-P Exam Study Set — 2026/2027
100–120 ms. Prolonged QRS duration in an infant may indicate ventricular hypertrophy, bundle branch
block, or pre-excitation. These age-adjusted norms are critical for interpreting pediatric ECGs, as applying
adult criteria would lead to many false-positive findings.
11. In patients with hypoplastic left heart syndrome (HLHS) after Fontan palliation, which
hemodynamic factor MOST contributes to the high prevalence of atrial arrhythmias?
A. Left ventricular dysfunction
B. Elevated central venous pressure and atrial dilation
C. Pulmonary hypertension
D. Systemic desaturation
Correct Answer: B. Elevated central venous pressure and atrial dilation
Rationale: Fontan physiology is characterized by passive systemic venous return to the pulmonary
arteries without a subpulmonary ventricle. This results in chronically elevated central venous pressure
(CVP) and progressive atrial dilation (particularly the right atrium or Fontan conduit). Elevated CVP,
atrial stretch, atrial fibrosis, and surgical scarring all contribute to the substrate for atrial arrhythmias,
particularly IART. While ventricular dysfunction (A), pulmonary hypertension (C), and desaturation (D)
are important complications, the atrial substrate is the primary driver of arrhythmia in this population.
12. Place the following stages of normal cardiac conduction system development in fetal life in
the correct sequence (1 = earliest, 5 = latest). [Ordered Response]
1. The His-Purkinje system develops and conducts impulses to the ventricles
2. The sinoatrial (SA) node becomes the dominant pacemaker
3. Cardiac impulse initially originates from the primitive ventricle
4. The AV node forms at the AV canal junction
5. Preferential internodal atrial pathways develop for fast AV conduction
Correct Answer: 3 → 4 → 1 → 5 → 2
Rationale: Cardiac conduction system development follows a characteristic sequence. Initially (3), the
primitive tubular heart contracts in a peristaltic fashion with impulses originating from the ventricle. As
the atria and ventricles separate, the AV canal region develops the AV node (4). The His-Purkinje system
then forms (1), allowing coordinated ventricular depolarization. Internodal pathways develop later (5),
facilitating rapid atrial-to-ventricular conduction. The SA node assumes dominance last (2), typically by
the end of the first trimester. Before SA node maturation, the AV node or lower atrial tissue may serve as
the dominant pacemaker, which explains some fetal and neonatal arrhythmia patterns.
13. A 5-year-old girl with a large secundum ASD presents with intermittent palpitations. ECG
shows a delta wave with a short PR interval. What is the significance of these findings?
A. Isolated WPW syndrome requiring ablation
B. Accessory pathway with antegrade pre-excitation in the setting of ASD
C. Ebstein anomaly with atrial septal defect
D. Lown-Ganong-Levine syndrome
Correct Answer: B. Accessory pathway with antegrade pre-excitation in the setting of ASD
Rationale: The finding of a delta wave and short PR interval indicates ventricular pre-excitation via an
accessory pathway. The coexistence of ASD and WPW can occur together, though the association is less
strong than with Ebstein anomaly. In this patient, the AP should be characterized with EP study,
particularly assessing for antegrade effective refractory period. ASD repair and AP ablation can often be
performed simultaneously. Lown-Ganong-Levine (D) features a short PR without a delta wave. Ebstein
anomaly (C) would typically have tricuspid valve displacement on echocardiography.
14. Which coronary artery anomaly is MOST associated with sudden cardiac death (SCD) in
young athletes?
4
