Part 2 | EP (Traces)

1. Interpret this intracardiac tracing

during an EPS study for a patient
with recurrent episodes of tachycardia

Pacing from lower right atrium:

 Pacing from Proximl CS catheter:

The previous maneuverers proved that:

A) Isthmus conduction is present in one direction only
B) Isthmus conduction is present in both direction
C) No Isthmus conduction
2. RF Ablation has been done for this patient in question 2, the following
maneuver has been done to confirm success of ablation:

Pacing from Lower right atrium:

Pacing from Proximal CS catheter:

The previous maneuvers proved:

a) Unidirectional Isthmus block
b) Bidirectional Isthmus block
c) Persistent Isthmus conduction

3. What is your decision based on the result of the maneuver done in

question 2:
a) Successful ablation, end of study
b) Further RF ablation application to reach end point
4. Describe the following fluoroscopic view:

LAO view at successful site of RF Ablation of:

a) Right Anterolateral accessory pathway
b) Right posteroseptal accessory pathway
c) Left posterolateral accessory pathway
d) Fast AVN pathway
5. What is the pink structure in this 3D anatomical map?

a) Left superior pulmonary vein

b) Left inferior pulmonary vein
c) Left atrial appendage
d) Right superior pulmonary vein
e) Right inferior pulmonary vein
6. According to the below map

At this stage, pulmonary veins isolation is done to:

a) Right pulmonary veins

b) Left pulmonary veins
c) Right & left pulmonary veins
7. According to the below map:

The ablation catheter is in:

a) Left superior pulmonary vein

b) Left inferior pulmonary vein
c) Left atrial appendage
d) Right superior pulmonary vein
e) Right inferior pulmonary vein
8.

The operator is doing:

a) Voltage map
b) Late activation map
c) Anatomical map
d) Pace map
9.

At this stage, pulmonary veins isolation is done to:

a) Right pulmonary veins
b) Left pulmonary veins
c) Right & left pulmonary veins

10. What is this view:

a) RAO
b) LAO
c) AP
d) PA
11.What is this view?

a) RAO
b) LAO
c) AP
d) PA
12.

Where is the Lasso catheter?

a) Left superior pulmonary vein

b) Left inferior pulmonary vein
c) Left atrial appendage
d) Right superior pulmonary vein
e) Right inferior pulmonary vein
13. The following three tracings were obtained during AF WACA ablation
used Carto system

Before ablation

During ablation
After Ablation

What is the end result of this ablation?

A. Pulmonary vein potentials disapperance
B. Pulmonary vein potentials dissociation
C. Presence of gaps of reconnection at some poles of lasso catheter
d. transient non conducted P waves
14.

What is the sequence of atrial activation?

A. Typical AVNRT
B. Atypical AVNRT
C. AVRT with concentric activation
D. AVRT with Eccentric activation.
15.

The earliest retrograde atrial activation is recorded at?

A) His catheter
B) CS 1-2
C) CS 9-10
D) Ablation catheter
E) His catheter 1,2
F) His catheter 3,4
16.Where is the site of pacing?

A. Right ventricle.
B. Left ventricle.
C. Right atrium
D. CS
E. His Bundle

17.This change happened during ablation, what should you do?

A. Continue ablation for two minutes
B. Stop ablation immediately
C. Adjust ablation catheter position and repeat ablation
18. This same case in question 18. After the first session of ablation, we do
RV pacing from His catheter, what is the next step?

A. Start RF ablation again after proper position of catheter.

B. End the study.
C. Give adenosine
D. Give atropine

19.We performed RV pacing after second RF ablation in the same patient,

what is the diagnosis?
A. Development of V-A dissociation, which is sure sign of successful concealed accessory
pathway ablation.
B. Development of intermittent 2:1 VA block.
C. Failure of RV capture
D. Simultaneous AV capture

20.What are the expected features of resting ECG post ablation of

concealed accessory pathway?
A. Change in the axis of QRS.
B. Persistent of pre-excitation.
C. No expected changes.
D. T wave inversion in the most preexited leads

21.The following intracardiac tracing for a 22 years old female patient

during slow pathway ablation for AVNRT tachyarrythmia.

What is your interpretation for this intracardiac tracing?

a. Fast junctional & non conducted Atrial beat.
b. Slow Junctional rhythm
c. Premature Atrial beats induced by the ablation catheter
22. What is your decision at that time concerning the findings of the intracardiac
tracing for this patient in question 21?
a. Stop ablation & evaluation of retrograde conduction
b. Continue ablation for 2 mins and reassess

23.This rhythm was during ablation of AVNRT.

Choose the correct answer:

a) AVNRT was induced

b) Slow Junctional rhythm during slow pathway ablation with intact 1:1 VA
conduction
c) Accelerated idioventricular rhytym
d) 2:1 AV block
24. What is the most likely location of sites A, B and C in relation to VT circuit?

a) A: entrance, B: exit, C: area of slow conduction

b) A: area of slow conduction, B: entrance, C: exit
c) A: dead-end pathway, B: entrance, C: exit
d) A: entrance, B: dead-end pathway, C: exit
e) A: area of slow conduction, B: exit, C: entrance
25.A 15 yrs old female complaining of recurrent attacks of palpitations.
This is her resting ECG.

Choose the correct answer:

a. Lown Ganong Levein Syndrome
b. Intermittent preexitation of left postero septal AP
c. Manifest right postero-septal Accessory Pathway
d. Manifest left posterior AP
e. Manifest right anteroseptal accessory pathway
26. Same patient in question 25, Tachycardia was induced during catheter
manipulation.

the mechanism of this tachycardia is:

a. Orthodromic AVRT
b. AVNRT
c. Atrial tachycardia
d. Ventricular tachycardia
27. The intra recording at the ablation catheter showed the following.

Choose the correct answer:

a. Good A & V at the site for ablation
b. Bad A & V at the site for ablation
c. No A is recorded on ablation catheter
d. No V is recorded on ablation catheter
28.

After septal AP ablation, Para-hisian pacing was done.

The test is not reliable because of:
a. VA dissociation
b. The pacing CL is longer than the intrinsic rhythm
c. There is failure of His Capture
d. AV dissociation
29.During AVNRT ablation, the following was noted:

This recording shows:

a. AV dissociation
b. Lower common pathway 2:1 block
c. Successful fast pathway modification
d. Rapid junctional rhythm

30. Where is the site of the AP that is associated with the lowest risk for the
complications of RF ablation during Ventricular pacing?
a. Left lateral AP
b. Antroseptal AP
c. Right Posteroseptal AP
d. Left posteroseptal AP

31. After ablation of AP and presence of intact retrograde AV node conduction, what is
the pharmacological test to be used?
a. Atropine injection
b. Adenosine injection
c. Verapamil injection
d. Isoproterenol injection
e. Adrenaline injection
32. During ablation of Typical AVNRT using 35 watt at the posterior Koch triangle, the
catheter recorded high impedance & watt became 5 watt, choose correct answer:
a. Catheter is jumped inside CS
b. Successful ablation of slow pathway
c. Heart block
d. Tamponade

33. After successful ablation of typical AVNRT, Ventricular pacing showed absence of
retrograde VA conduction with the presence of antegrade Jump.

What is the recommended next step?

a. Continue ablation
b. Pacemaker implantation
c. Stop ablation & wait for recovery
d. Atrial pacing and atrial extra stimulation
34.According to the below intra cardiac recording:

Choose the correct answer:

a. Rapid Junctional rhythm
b. AV dissociation
c. 2:1 Heart block
d. Atrial Tachycardia
e. Sinus rhythm then runs of non-sustained VT
35. In the following intracardiac recording, choose the correct answer:

a. Ventricular pacing with 1:1 conduction

b. CS 3-4 pacing with 1:1 conduction
c. CS 3-4 pacing with 2:1 conduction
d. Atrial pacing with 1:1 conduction
36. In the following intra cardiac recording, choose the correct answer:

a. Atrial flutter
b. Atrial tachycardia
c. Atrial fibrillation with conduction throw AV node
d. Atrial fibrillation with conduction throw an Accessory pathway
37. In the following intra cardiac recording, LV pacing (Abo’s Manoeuver ) showed :

a. Retrograde conduction via the Accessory pathway

b. VA dissociation
c. Retrograde conduction via the AV node
d. Non capture of the ablation catheter
38. The following intracardiac recording shows what type of tachycardia?

A. Antidromic tachycardia.
B. Orthodromic tachycardia.
c. Ventricular tachycardia
d. Atrial flutter with 1:1 conduction

39. As shown in the following intracardiac recording, what is the next step?
A. Stop the ablation immediately & reposition ablation catheter
B. Stop the ablation and perform retrograde conduction confirmation
C. Continue the ablation for 120 seconds
40. After RF ablation of an AP site, and at the end of the waiting period post ablation,
the patient showed the following intracardiac tracing:

What is the next step?

A. Re- starts ablation of accessory pathway.
B. Return patient to the sinus rhythm and end the study.
c. Return patient to the sinus rhythm and re- ablate the accessory pathway
d. It is a sign of successful ablation of AP
41. 63 years old female complains of recurrent attacks of palpitations. These Attacks
which have been started for two years, increase in frequency and duration. It occurs
at rest with Sudden onset and offset, patient needed referral to ER receiving IV
verapamil
She was kept on medical treatment in the form of Verapamil 80 mg T.D.S with no
improvement. Negative FH of medical importance.

Intracardiac EGM during tachycardia:

Entrainment from RV apex with

Post Pacing interval – TCL = 140 msec

What is the diagnosis?

a. AVNRT
b. AVRT
c. Facicular VT
d. Automatic atrial tachycardia
42. Female 12 yrs old complaining of recurrent attacks of palpitations since the age of
4 years occurring at rest and during exercise of sudden onset , paroxysmal pattern.
The patient complained of recurrent attacks of palpitation associated with
dizziness, but no syncope .She sought medical advice and was kept on Sotalol for
three years and then replaced by verapamil, However there was no significant
improvement.
Decision was to do EPS with possible ablation.

What is the type of pacing?

a. Atrial Pacing
b. Atrial Extra stimulus
c. Ventricular pacing
d. Ventricular Extra stimulus

43. Describe the intracardiac tracing in the previous question?

a. A-H jump after S2 & two tachycardia beats
b. Reached AVN ERP
c. Induction of orthodromic tachycardia
d. Loss of capture
44. A 35 year old female patient complains of palpitations.

A- Intracardiac tracing shows manifest preexciation (Right posteroseptal AP) during

sinus rhythm
B- Intracardiac tracing shows manifest preexciation (Right posteroseptal AP) during
tachycardia
C- Intracardiac tracing shows manifest preexciation (left lateral AP) during
tachycardia
D- Intracardiac tracing shows manifest preexciation (left lateral AP) during sinus
rhythm
45. During EP study, the patient developped this rhythm. Choose the crrect aswer
describing this tracing:

A- Antidromic tachycardia
B- Atrial Flutter
C- Atrial fibrillation with intermittent preexcitation
D- Atrial fibrillation with short run of ventricular tachycardia
46. comment on intracrdiac tracing:

A- AVRT utilising a right posteroseptal AP

B- AVRT utilising a right anteroseptal AP
C- AVRT utilising a left lateral AP
D- AVNRT
47. : comment on intracardiac tracing:;

A- Typical Counter clockwise Atrial flutter with 2:1 conduction

B- Ectopic Atrial tachycardia with 1:1 conduction
C- Typical clockwise atrial flutter with 1:1 Conduction
D- Atypical atrial flutter with 1:1 conduction
48. A 37 year old female has suffered from exercise related arrhythmia for one year.
So Holter mointoring was recommended and then she was referred for EP study.

Tracing shows the12-lead ECG morphology and 3D mapping during this

arrhythmia.
Which statement is correct?
a) This is an activation map used Carto system and The PVC exit site is located in
the right ventricular outflow tract.
b) This is a voltage map used Ensite velocity system and The PVC exit site is
located in the right ventricular outflow tract
c) This is an activation map used Ensite velocity system and The PVC exit site is
located in the left ventricular outflow tract.
d) This is a voltage map used Carto system and The PVC exit site is located in
the left ventricular outflow tract.
49. A 51 year old male suffered from daily infrequent attacks of palpiations in form of
skipped beats for 20 years. Five months ago these attacks became frequent and
continuous for few minutes.
According to the ECG and the activation map of this arrhythmia, what is this
structure labelled with yellow arrow?

a) Ostium of coronary sinus

b) Left coronary artery
c) Superior vena cava
d) Right coronary artery
50. This figure shows:

Choose the correct answer:

A. 1-Carto mapping LA and 4 Pulmonary veins showing right and left WACA
B. 2-Navix 3D mapping of LV showing scar VT ablation
C. 3-CARTO mapping of RVOT showing PVC ablation
D. 4-Navix mapping and ablation of focal atrial tachycardia