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IBHRE allied professional · Last updated November 2026

IBHRE Certified Cardiac Device Specialist (CCDS) Exam: free practice test

The IBHRE credential for allied professionals who implant, program and follow pacemakers, ICDs, CRT systems and loop recorders. It runs once a year: the next exam is August 4, 2027 (applications close March 18, 2027). The 2026 outline has 10 domains, led by Patient and Device Follow-Up Management (20%) and Device Functions and Algorithms (14%). IBHRE reported a 66.57% pass rate for 2025.

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About the CCDS exam

The IBHRE credential for allied professionals who implant, program and follow pacemakers, ICDs, CRT systems and loop recorders. It runs once a year: the next exam is August 4, 2027 (applications close March 18, 2027). The 2026 outline has 10 domains, led by Patient and Device Follow-Up Management (20%) and Device Functions and Algorithms (14%). IBHRE reported a 66.57% pass rate for 2025.

What's on the exam

CCDS
Electrophysiology and Engineering Fundamentals
6 key facts
Sensing, Stimulation and Timing Cycles
7 key facts
Device Functions and Algorithms
6 key facts
ECG, Paced Rhythms and Radiology
6 key facts
Clinical Assessment and Implant Practice
6 key facts
Safety: EMI, MRI and Advisories
6 key facts
Follow-Up and Troubleshooting
7 key facts

Each branch is a topic in the official outline. Members see every key fact on the full mind map. Read the free study guide →

How to pass the CCDS exam

  • 200 questions in 240 minutes is 72 seconds each, but each section has its own hard time limit and you can't go back. Pace each section on its own.
  • Follow-up management is the largest domain (20%). Expect tracings: oversensing, undersensing, loss of capture, upper-rate behavior and pseudo-malfunction.
  • Know the timing-cycle arithmetic cold: VA interval, total atrial refractory period, 2:1 block rate, Ohm's law. These are fast points if you don't have to think.
  • IBHRE gives you on-screen calipers and a calculator. Practise reading intervals on tracings with calipers, not just answering text questions.

Save your results and get your Readiness Score

Create a free account after the test: your score by topic, a mistakes bank, the complete study notes for the first topic, flashcards and the Device Timing & Values Sheet.

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What's in the premium CCDS prep

Premium CCDS prep is studied one topic at a time. Each step starts with that topic's key notes and flashcard deck, then its own question sets of 25, so you master one topic before you move to the next. When every topic is strong, the 6 full mock exams show you're ready.

3,000practice questions, every answer explained
6full-length mock exams, 200 questions each, timed
800flashcards with spaced repetition, sorted by topic
60comprehensive key notes across 7 topics

Your step-by-step study path

  1. 1
    Electrophysiology and Engineering Fundamentals9 key notes, 115 flashcards, then 450 practice questions in 18 sets of 25
    Notes free with an account
  2. 2
    Sensing, Stimulation and Timing Cycles9 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25
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  3. 3
    Device Functions and Algorithms9 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25
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  4. 4
    ECG, Paced Rhythms and Radiology9 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25
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  5. 5
    Clinical Assessment and Implant Practice8 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25
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  6. 6
    Safety: EMI, MRI and Advisories8 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25
    Premium
  7. 7
    Follow-Up and Troubleshooting8 key notes, 110 flashcards, then 425 practice questions in 17 sets of 25
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  8. Final step: 6 full mock exams200 questions each, timed like test day. Pass them, then book your exam.
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Free with an account

Read the complete CCDS study notes for “Electrophysiology and Engineering Fundamentals”

Our first full set of comprehensive notes, about 15 minutes of reading: The conduction system, in order · Ohm's law and its relatives · The strength-duration curve · Batteries, capacitors and circuits · Leads and connectors, a worked exam example, the traps examiners use and a one-minute recap. Create a free account to read it and see how premium notes work before you decide.

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Study tools included

3,000 practice questions

3,000 exam-style questions per exam, organized topic by topic in sets of 25. Every answer explained, with the rule it comes from.

6 full mock exams

6 full-length timed mock exams per exam, with real question counts and time limits, so test day feels like practice day.

Exam Readiness Score

One 0 to 100 number that tells you when you're ready to book. Reach 80 and you're covered by our Pass Guarantee.

800 flashcards + spaced repetition

800 flashcards per exam, in a deck for each topic, that come back right before you'd forget them. Five minutes a day keeps every number fresh.

60 comprehensive key notes

60 key notes per exam, split across its topics and each explained in full: the concepts, worked exam examples, the traps examiners use and a quick recap. Your first set is free with an account.

Mind maps

See the whole exam on one screen: every topic and the facts under it.

Sample questions with answers

These are the questions in the free test above, with answers. Try the test first. You'll learn more by getting some wrong.

1. A pacemaker delivers a 5.0 V pulse into a lead with a measured pacing impedance of 500 Ω. What current flows during the pulse?
Answer: 10 mA. Ohm's law: I = V ÷ R = 5.0 V ÷ 500 Ω = 0.010 A = 10 mA. Lower impedance means more current drain at the same voltage, which is why high-impedance leads extend battery life.
2. On a strength-duration curve, chronaxie is defined as:
Answer: The pulse width at which the threshold voltage is twice the rheobase. Rheobase is the lowest voltage that captures at a very long pulse width. Chronaxie is the pulse width at which threshold equals twice the rheobase. Energy threshold is lowest at a pulse width close to chronaxie.
3. A DDD pacemaker using ventricular-based timing is programmed to a lower rate of 60 ppm and a paced AV delay of 200 ms. What is the atrial escape (VA) interval?
Answer: 800 ms. The lower rate interval is 60,000 ÷ 60 = 1,000 ms. With ventricular-based timing, VA interval = lower rate interval − AV delay = 1,000 − 200 = 800 ms.
4. A DDD pacemaker has an upper tracking rate of 120 ppm, a sensed AV delay of 150 ms and a PVARP of 250 ms. At about what atrial rate will 2:1 block occur?
Answer: 150 bpm. Total atrial refractory period (TARP) = sensed AV delay + PVARP = 150 + 250 = 400 ms. The 2:1 block rate = 60,000 ÷ 400 = 150 bpm. Between the upper tracking rate (120) and 150 bpm you'd see pacemaker Wenckebach.
5. A patient with retrograde VA conduction of 320 ms has recurrent pacemaker-mediated tachycardia (PMT) in DDD mode. Which change most directly prevents it?
Answer: Lengthen the PVARP to about 350 ms. PMT is sustained when a retrograde P wave falls outside PVARP, is sensed and tracked, and triggers another ventricular paced beat. A PVARP longer than the retrograde VA time stops those P waves from being tracked. The trade-off is a longer TARP and a lower 2:1 block rate.
6. Antitachycardia pacing (ATP) terminates monomorphic reentrant VT mainly by:
Answer: Pacing into the excitable gap so a paced wavefront blocks the circuit. Burst or ramp pacing slightly faster than the VT enters the excitable gap of the reentry circuit. The paced wavefront collides with and blocks the circulating wavefront. A shock, by contrast, depolarizes the whole myocardium.
7. Pacing from a lead at the right ventricular apex usually produces which surface ECG pattern?
Answer: Left bundle branch block pattern with a superior (left) axis. The RV is activated first, so the paced QRS looks like LBBB. From the apex the wavefront spreads upward, giving a superior axis. RV outflow tract pacing gives LBBB with an inferior axis; a right bundle pattern suggests LV pacing.
8. On a lateral chest X-ray, a left ventricular lead placed through the coronary sinus into a lateral branch points:
Answer: Posteriorly, toward the spine. The coronary sinus runs in the posterior atrioventricular groove, so a CS lead heads posteriorly on the lateral view. An RV apical lead points anteriorly and inferiorly. The lateral film is how you tell them apart.
9. Under the 2018 ACC/AHA/HRS bradycardia guideline, which finding is a Class 1 indication for a permanent pacemaker when no reversible cause is found?
Answer: Acquired Mobitz type II second-degree AV block, even without symptoms. Acquired Mobitz II, high-grade or third-degree AV block not due to reversible or physiologic causes warrants pacing regardless of symptoms. Asymptomatic sinus bradycardia, first-degree block and Mobitz I in athletes are not indications.
10. At implant, which set of RV lead measurements is generally acceptable?
Answer: Threshold 0.6 V at 0.5 ms, R wave 10 mV, impedance 650 Ω. Typical acute targets are a ventricular threshold under 1.0 V at 0.5 ms, an R wave above 5 mV and an impedance within the lead's normal range (often about 300 to 1,200 Ω). A 2.5 V threshold, a 2 mV R wave or a 150 Ω impedance would each need the lead repositioned or checked.
11. A patient has purulent drainage from the generator pocket and blood cultures positive for Staphylococcus aureus. What is the recommended management?
Answer: Complete removal of the generator and all leads, with antibiotics. The 2017 HRS expert consensus recommends complete system removal (generator and all leads) for definite CIED infection, including pocket infection and bacteremia, alongside antibiotics. Partial removal or antibiotics alone has a high relapse rate.
12. A pacemaker-dependent patient will have chest surgery with monopolar electrosurgery near the device. What is the most appropriate device plan?
Answer: Program an asynchronous pacing mode (or use a magnet if it gives asynchronous pacing) for the procedure. Electrosurgery can be oversensed and inhibit pacing, which is dangerous in a dependent patient. Asynchronous pacing ignores sensed signals. Making sensing more sensitive increases oversensing, and switching pacing off removes the escape rhythm the patient depends on.
13. A chronic bipolar pacing lead's impedance has fallen from 620 Ω to 180 Ω over three months. What is the most likely cause?
Answer: Insulation breach. An insulation breach lets current leak, so impedance falls (often below 200 Ω). Conductor fracture and a loose set screw raise impedance. Exit block raises the capture threshold but doesn't usually change impedance much.
14. In a dual-chamber pacemaker, each P wave is sensed normally, followed by a second small atrial-channel sensed event that coincides with the surface QRS. The device logs frequent mode switches during sinus rhythm. What is the most likely problem?
Answer: Far-field R-wave oversensing on the atrial channel. The atrial lead is picking up ventricular depolarization. The extra 'atrial' events double the counted atrial rate and trigger inappropriate mode switching. Fixes include lengthening the post-ventricular atrial blanking period or making the atrial channel less sensitive.
15. A patient reports rhythmic twitching of the arm. The chest X-ray shows the leads coiled around the generator and the lead tips pulled back from the heart. What is the diagnosis?
Answer: Twiddler syndrome. In Twiddler syndrome the patient rotates the generator in its pocket, winding the leads and retracting them. Displaced electrodes can stimulate the brachial plexus or diaphragm and lose capture. Treatment is surgical revision and securing the device.

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Certification guide

IBHRE CCDS exam guide (2027): The Certified Cardiac Device Specialist (CCDS) exam from the [International Board of Heart Rhythm Examiners](https://ibhre.org/Allied-Professionals/CCDS-Exam) is the main credential for allied professionals who implant, program and follow cardiac implantable electronic devices. It's 200 multiple-choice questions in 4 hours, offered once a year. Here's what's on it and how to prepare.

CCDS exam FAQ

How many questions are on the CCDS exam?

200 multiple-choice questions in 4 timed sections, with a time limit of 4 hours (240 minutes), with 6-minute breaks between sections; you can't return to a finished section. Format: closed book, computer-based (on-screen calculator and calipers provided).

What is the passing score for CCDS?

Not published. IBHRE sets a criterion-referenced cut score and reports a scaled score; practise to 75% or higher.

How much does the CCDS exam cost?

US$1,090 for the August 4, 2027 exam (same for HRS members, non-members and retakes); the August 5, 2026 exam was US$990. Fees and deadlines change each year, so confirm on the IBHRE website before you apply.

Which languages is the CCDS exam offered in?

English.

Where do I take the CCDS exam?

PSI test centers in North America and internationally (no remote option listed by IBHRE).

Is this CCDS practice test free?

Yes. The 15-question practice test on this page is free, with an explanation for every answer and no signup. A free account also unlocks the complete study notes for the first topic. The full CCDS prep is Premium at $147 a month for this exam.

What's in the premium CCDS prep?

3,000 practice questions organized topic by topic (Electrophysiology and Engineering Fundamentals: 450; Sensing, Stimulation and Timing Cycles: 425; Device Functions and Algorithms: 425; ECG, Paced Rhythms and Radiology: 425; Clinical Assessment and Implant Practice: 425; Safety: EMI, MRI and Advisories: 425; Follow-Up and Troubleshooting: 425), 6 full-length timed mock exams of 200 questions, 800 flashcards and 60 comprehensive key notes split across all 7 topics, plus a mistakes bank and the Readiness Score.

Compare CCDS with the other IBHRE exam

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Exam details are summarized from the official candidate information available in November 2026. IBHRE changes formats and fees, so confirm with International Board of Heart Rhythm Examiners (IBHRE) before you book. CCDSExamPrep is not affiliated with IBHRE, the Heart Rhythm Society or PSI.

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