EP Quiz Archive
EP Quiz #97
A 36-year-old female competitive cyclist with CPVT has had VF arrest on a river swim. She is on flecainide + nadolol. She requests return-to-sport clearance. What is the guidance?
EP Quiz #96
A 58-year-old with persistent AF and significant LA fibrosis (Utah stage III on MRI) undergoes extended PVI + posterior wall isolation. What is the expected 12-month outcome?
EP Quiz #95
ECG: narrow complex tachycardia at 150 bpm with no visible P waves, sudden onset, and abrupt termination with adenosine. 12-lead during tachycardia versus sinus — interpret.
EP Quiz #94
A 45-year-old with drug-resistant AF (failed PVI x2) is considered for convergent procedure. What is the approach, outcomes and patient selection for convergent ablation?
EP Quiz #93
A 62-year-old undergoes His-bundle pacing for AF with slow ventricular response and AV block. After 2 years, his His-bundle threshold rises to 2.5V. What is the management?
EP Quiz #92
A 25-year-old with an SCN5A loss-of-function mutation has asymptomatic RBBB and sinus bradycardia. No Brugada pattern at baseline. Ajmaline challenge is positive. Management?
EP Quiz #91
A 52-year-old with ischaemic CM, RBBB and QRS 148 ms is referred for CRT. Current guidelines recommend CRT for LBBB. What is the evidence for RBBB + CRT?
EP Quiz #90
A 70-year-old with AF undergoes rate control with a beta-blocker. Despite a resting rate of 72, his 6MWT shows rate >140. What is the target rate and drug strategy?
EP Quiz #89
A patient with intermittent pre-excitation and a structurally normal heart is referred. His EPS shows shortest pre-excited RR interval of 260 ms during AF. Is ablation mandatory?
EP Quiz #88
A 44-year-old with a left-lateral accessory pathway undergoes radiofrequency ablation. During lesion delivery at the mitral annulus, the aortic valve is injured. What happened?
EP Quiz #87
A 65-year-old with ischaemic CM undergoes subcutaneous ICD implantation (not eligible for TV-ICD due to infected pocket). What are the limitations of S-ICD compared to TV-ICD?
EP Quiz #86
A 24-year-old with a structurally normal heart presents with idiopathic polymorphic VT not triggered by exercise. Adenosine terminates the episodes. What is the likely mechanism?
EP Quiz #85
A 59-year-old with congenital complete heart block has a VVI pacemaker since childhood. He now has RV dysfunction from pacing-induced cardiomyopathy. What is the upgrade strategy?
EP Quiz #84
An 80-year-old with AF and renal failure has a high haemorrhagic and stroke risk (CHA₂DS₂-VASc 5, HAS-BLED 4). How do you balance anticoagulation decisions?
EP Quiz #83
A 33-year-old asymptomatic male has Brugada pattern on ECG during a pre-employment screening. His father died suddenly at 45. What is the risk stratification algorithm?
EP Quiz #82
A 58-year-old diabetic with DN nephropathy (eGFR 22) has AF and is on rivaroxaban. His renal function deteriorates. What are the anticoagulation options at very low GFR in AF?
EP Quiz #81
A 41-year-old with peripartum cardiomyopathy (EF 30%) is 3 months post-delivery. She has NSVT. Should she receive an ICD or a wearable defibrillator in the acute phase?
EP Quiz #80
A 47-year-old with AF and obstructive sleep apnoea. He has not been treated for OSA. His AF recurrence rate post-ablation is high. What is the relationship between OSA and AF?
EP Quiz #79
A 62-year-old with ischaemic CM, EF 28%, recurrent VT despite amiodarone and prior ablation — what is the role of VT ablation in this setting per current guidelines?
EP Quiz #78
A 55-year-old with persistent AF is being considered for hybrid ablation (thoracoscopic epicardial + catheter endocardial). What are the outcomes compared to catheter-only ablation?
EP Quiz #77
A 69-year-old with AF undergoes LAAO with Watchman FLX. At 45-day TOE, a device-related thrombus is seen. What is the incidence, risk factors and management?
EP Quiz #76
A 43-year-old with non-ischaemic CM and EF 20% has LBBB. He is symptomatic despite OMT. CRT implant is planned. What is the evidence for conduction system pacing vs conventional CRT?
EP Quiz #75
A 52-year-old post-MI patient has a ventricular aneurysm and hemodynamically stable VT. Endocardial mapping shows a large scar. What are the ablation strategies?
EP Quiz #74
Identify: ECG shows P wave morphology changing every 3 beats in a 55-year-old with COPD and hypoxia. What is the arrhythmia and how do you treat the underlying cause?
EP Quiz #73
A patient with subcutaneous ICD (S-ICD) has oversensing of myopotentials leading to inappropriate therapy. What are the programming solutions for S-ICD oversensing?
EP Quiz #72
A 36-year-old with long QT-2 (KCNH2 mutation) is on nadolol. She is pregnant (28 weeks). What are the arrhythmia risks during pregnancy and management strategies?
EP Quiz #71
A 70-year-old post-MV repair patient has junctional escape rhythm at 42 bpm with 3rd degree AV block. He is 10 days post-surgery. Is the AV block expected to recover?
EP Quiz #70
A 44-year-old female with atrial tachycardia after prior PVI presents with recurrent AF. The AT shows centrifugal activation from the posterior left atrium. What is the mechanism?
EP Quiz #69
A 34-year-old with Anderson-Tawil syndrome has periodic paralysis, QT prolongation, and ventricular arrhythmias. What is the genotype-phenotype correlation and management?
EP Quiz #68
ECG shows ST elevation with RBBB and left axis deviation in a haemodynamically unstable patient with wide complex tachycardia. What is the differential and immediate management?
EP Quiz #67
A 60-year-old with cardiac amyloidosis has sinus node dysfunction and AV block. He has poor prognosis. What are the pacing considerations in infiltrative cardiomyopathy?
EP Quiz #66
A 48-year-old presents with a dual tachycardia (atrial flutter with intermittent AVNRT). How do you manage coexisting arrhythmias in the EP lab?
EP Quiz #65
A 52-year-old with drug-refractory AVNRT is referred for ablation. During the procedure, steam-pop is heard. What are the complications of radiofrequency ablation?
EP Quiz #64
A 25-year-old with Emery-Dreifuss muscular dystrophy has 1st degree AV block and AF. When is prophylactic pacemaker or ICD implantation indicated in EDMD?
EP Quiz #63
A 67-year-old with AF post-cardiac transplant. What are the unique electrophysiological features of the transplanted heart and how is AF managed?
EP Quiz #62
A 38-year-old athlete with asymptomatic pre-excitation (WPW pattern on ECG). Exercise test shows persistent pre-excitation at peak HR. What is the next step?
EP Quiz #61
A 55-year-old with persistent AF has left atrial appendage thrombus on CT. After 4 weeks of anticoagulation, thrombus persists. What is your ablation strategy?
EP Quiz #60
A 48-year-old female with mixed connective tissue disease has AV block and sinus node dysfunction. How do ANA/anti-Ro antibodies relate to conduction disease?
EP Quiz #59
A 61-year-old post-MI patient has recurrent monomorphic VT despite amiodarone. He has undergone one prior ablation. What is the role of stereotactic body radiotherapy for VT?
EP Quiz #58
A 70-year-old with a transvenous ICD presents with pocket infection. Blood cultures are negative. How do you manage infected cardiac implantable electronic devices?
EP Quiz #57
A 32-year-old with idiopathic outflow tract VT has PVCs from the aorto-mitral continuity. What ECG features localise PVCs to this region? What are the ablation risks?
EP Quiz #56
A paced rhythm with 100% RV pacing shows low-amplitude far-field R-wave oversensing during T-wave. The ICD delivers inappropriate therapy. How do you reprogram to avoid this?
EP Quiz #55
A 53-year-old with PVC-induced cardiomyopathy has EF 35% and 24% PVC burden. He undergoes successful ablation. What is the expected recovery in EF and timeline?
EP Quiz #54
Identify: ECG shows a regularly irregular rhythm at 90 bpm with variable PR interval, progressive PR lengthening, then a dropped beat. What is the block type and level?
EP Quiz #53
A 40-year-old male has persistent AF and is undergoing cryoballoon PVI. The right inferior PV has an unfavourable anatomy. How do you manage difficult PV anatomy?
EP Quiz #52
A 45-year-old with hypertrophic obstructive cardiomyopathy has gradient of 50 mmHg at rest. He has non-sustained VT and presyncope. Does he need an ICD?
EP Quiz #51
A 58-year-old with ischaemic CM, EF 30%, and LBBB undergoes CRT implant. His 6-month echo shows non-response. What defines non-response and what are the corrective steps?
EP Quiz #50
A patient with a Jervell-Lange-Nielsen syndrome has corrected QT of 560 ms. Nadolol has failed twice. He has had 4 appropriate ICD shocks this year. What is the next step?
EP Quiz #49
A 35-year-old male athlete collapses during football. ECG shows short-coupled PVCs initiating polymorphic VT. No structural disease. What is the diagnosis and management?
EP Quiz #48
A 63-year-old post-TAVR patient has new LBBB with QRS 160 ms. EF drops to 40% in 3 months. What is the threshold for pacing/CRT after TAVR?
EP Quiz #47
A 27-year-old female with recurrent SVT is found to have an epicardial accessory pathway (Mahaim). The ablation requires epicardial access. What are the challenges?
EP Quiz #46
A wide-complex tachycardia is seen in an 80-year-old. He is haemodynamically stable. The Brugada criteria suggest VT. What are the safe steps before DC cardioversion?
EP Quiz #45
A 50-year-old with persistent AF and valvular AF (mitral stenosis). His valve score makes him unsuitable for ablation. What is the anticoagulation strategy? OAC choice?
EP Quiz #44
A 66-year-old on chronic amiodarone develops sinus bradycardia at 42 bpm and symptomatic pauses. He has ischaemic cardiomyopathy. Should amiodarone be stopped?
EP Quiz #43
A 44-year-old with Lenegre-Lev disease has progressive RBBB + LAFB. His PR is 280 ms and H-V is 80 ms. What is the annual risk of complete heart block?
EP Quiz #42
A 56-year-old with dual AV nodal physiology has AVNRT with a fast-slow variant. The retrograde P waves precede the QRS. What is the ablation target?
EP Quiz #41
A 29-year-old with focal atrial tachycardia originating from the right pulmonary vein-atrial junction. Map-guided ablation is planned. What are the anatomical landmarks?
EP Quiz #40
A 71-year-old with atrioventricular block 2:1 and no structural heart disease. HV interval is 76 ms on EP study. Is prophylactic pacing indicated? Which lead position?
EP Quiz #39
A 38-year-old with idiopathic VF survives a cardiac arrest. Genetic panel reveals a SCN5A mutation. His Brugada pattern is inducible with procainamide. What is the management?
EP Quiz #38
A 52-year-old with cardiac sarcoidosis has non-sustained VT and EF 40%. Cardiac MRI shows extensive LGE. PET scan shows active inflammation. What is your approach?
EP Quiz #37
Identify the mechanism: a wide complex tachycardia at 170 bpm with VA dissociation and QRS morphology identical to sinus rhythm. What is the diagnosis?
EP Quiz #36
A 47-year-old with persistent AF undergoes pulmonary vein isolation. After 6 months, AF recurs at 3 months. How do you manage recurrent AF post-ablation?
EP Quiz #35
A 64-year-old has had a VVI pacemaker for 10 years. He now has AV block with pacemaker dependency. Upgrade to which device and via which approach?
EP Quiz #34
A 17-year-old with HCM and VF arrest is referred for ICD. His family history includes sudden death in two relatives. What are the programming considerations in young ICD recipients?
EP Quiz #33
A 55-year-old woman has frequent PVCs (22% burden) with RBBB morphology and superior axis. She is asymptomatic. When is ablation recommended for idiopathic PVCs?
EP Quiz #32
A patient with VT after amiodarone toxicity. Thyroid function is abnormal. He has visual disturbance and peripheral neuropathy. What are safe antiarrhythmic alternatives?
EP Quiz #31
A 42-year-old female with palpitations has a 12-lead ECG showing RP > PR with retrograde P waves. What are the differential diagnoses and how do you distinguish them?
EP Quiz #30
A 61-year-old has complete LBBB with 1st degree AV block. His PR interval is 220 ms. Echo shows severe LV dysfunction. What is the risk of pacemaker dependence post-CRT implant?
EP Quiz #29
A 33-year-old with catecholaminergic polymorphic VT is on high-dose nadolol. He has a recurrent syncopal event during exercise stress testing. What next?
EP Quiz #28
A 58-year-old with hypertensive heart disease has paroxysmal AF. He is on flecainide 100 mg BD. He now presents with haemodynamic instability and wide complex tachycardia.
EP Quiz #27
Identify the tachycardia: narrow complex at 140 bpm, retrograde P waves within the ST segment, 1:1 VA relationship, inducible with a single atrial extrastimulus.
EP Quiz #26
A teenager with Wolff-Parkinson-White syndrome is asymptomatic. His parents are concerned. What is the role of programmed electrical stimulation in risk stratification?
EP Quiz #25
A 66-year-old post-CABG patient develops 2:1 AV block post-operatively. His HV interval on EP study is 90 ms. What is the prognosis and management?
EP Quiz #24
A 30-year-old with ARVD/C has RV-origin VT. Substrate mapping reveals the triangle of dysplasia. What are the ablation targets? What is the recurrence risk?
EP Quiz #23
A 45-year-old marathon runner has sinus bradycardia at 38 bpm and is asymptomatic. His Holter shows nocturnal pauses of 2.5 seconds. Is pacing indicated?
EP Quiz #22
A 72-year-old with sick sinus syndrome has sinus pauses up to 4 seconds on Holter. He has intermittent dizziness. What pacing mode is most appropriate?
EP Quiz #21
A 50-year-old presents with irregular palpitations. His ECG shows atrial flutter at 300 bpm with variable block. What is the preferred ablation target?
EP Quiz #20
A 60-year-old with ischaemic cardiomyopathy undergoes VT ablation. Activation mapping during stable VT reveals the exit point. What is the ablation endpoint?
EP Quiz #19
Interpret this intracardiac electrogram. A patient with a CRT-D presents with inappropriate shocks. What is the cause and corrective programming?
EP Quiz #18
A long QT ECG is seen in a 19-year-old female started on azithromycin. Her baseline QTc was 430 ms, now 520 ms. What is your immediate management?
EP Quiz #17
A 48-year-old with dilated cardiomyopathy, EF 25%, LBBB with QRS 152 ms is referred. What are the indications for CRT-D? How do you optimise device programming?
EP Quiz #16
A 65-year-old diabetic with LV dysfunction (EF 30%) has non-sustained VT on Holter. His NYHA class is II. Does he qualify for an ICD? What guidelines apply?
EP Quiz #15
A 35-year-old presents with syncope. His 12-lead shows a delta wave with short PR. Accessory pathway localisation on ECG — identify the pathway location.
EP Quiz #14
A 40-year-old female with no structural heart disease has recurrent AVNRT. She had two DC cardioversions in the past year. Is ablation indicated? What are the risks?
EP Quiz #13
A 75-year-old with a dual-chamber pacemaker presents with 3-second pauses. The device interrogation shows appropriate sensing but inhibited pacing. What is the likely cause?
EP Quiz #12
A 68-year-old with AF is on anticoagulation. Her CHA₂DS₂-VASc score is 4. She has persistent AF with rate control failure. When is rhythm control preferred?
EP Quiz #11
A 22-year-old athlete develops syncope during exertion. His ECG shows the Brugada type 1 pattern after fever. Genetic testing is pending. How do you manage?
EP Quiz #10
A 55-year-old post-MI patient is referred for VT ablation. Endocardial mapping reveals a large area of low voltage in the inferior wall. What are the ablation strategies?
EP Quiz #9
A 28-year-old male presents with palpitations and pre-syncope. 12-lead ECG shows a narrow complex tachycardia at 180 bpm. What is the diagnosis and management?