CEPS Exam Study Guide (2026)
Everything the IBHRE Certified Electrophysiology Specialist (CEPS) Exam tests, topic by topic: what each section covers, the facts that come up most, and how to study it. Pair it with the free 15-question practice test.
The exam at a glance
| Questions | 200 multiple-choice questions (180 scored) in 4 timed sections |
|---|---|
| Time | 4 hours (240 minutes), with 6-minute breaks between sections; you can't return to a finished section |
| Passing score | Not published. IBHRE sets a criterion-referenced cut score and reports a scaled score; practise to 75% or higher |
| Format | Closed book, computer-based (on-screen calculator and calipers provided) |
| Certifying body | International Board of Heart Rhythm Examiners (IBHRE) |
| Test provider | PSI test centers in North America and internationally (no remote option listed by IBHRE) |
Mind map: the whole exam on one screen
Read the complete CEPS study notes for “Physics, Anatomy and Physiology”
Our first full set of comprehensive notes, about 15 minutes of reading: Signals and filters · Ablation biophysics · Right heart anatomy you'll see on tracings · Left heart and nearby structures · Conditions that change the substrate, 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.
1. Physics, Anatomy and Physiology
Domains 1 and 2 (15% together): units and signal concepts, filters and electronic circuitry, the biophysics of RF and cryo ablation, cardiac and conduction system anatomy, and acquired and inherited cardiac conditions.
Key facts
- Intracardiac bipolar EGMs are usually filtered about 30 to 500 Hz; unipolar signals use a wider bandpass to keep morphology.
- Radiofrequency ablation heats tissue resistively; irreversible injury starts at about 50 °C. Cryoablation freezes tissue and allows reversible 'cryomapping' before a permanent lesion.
- Koch's triangle (tendon of Todaro, septal tricuspid annulus, CS ostium) holds the compact AV node at its apex and the slow pathway region near the CS ostium.
- The crista terminalis separates the smooth and trabeculated right atrium and is a common site of focal atrial tachycardia.
- The pulmonary veins drain into the left atrium; their muscular sleeves trigger most paroxysmal AF.
- The phrenic nerves run near the SVC, the right superior pulmonary vein and the lateral LA or LV, so they are at risk during ablation there.
Flashcards
Exam tip: Anatomy questions often show a fluoroscopy or 3D-map view. Learn where each catheter sits in RAO and LAO projections.
2. Fundamentals of Electrophysiology
Domain 4 (20%): conduction system properties and normal intervals, the cardiac action potential, abnormalities of conduction and the three mechanisms of arrhythmia.
Key facts
- Normal adult intervals: AH about 55 to 125 ms (it varies with autonomic tone), HV 35 to 55 ms (little affected by autonomic tone).
- Myocyte action potential: phase 0 sodium influx, phase 1 early repolarization, phase 2 calcium plateau, phase 3 potassium repolarization, phase 4 resting.
- Nodal cells depolarize with the slow calcium current and have spontaneous phase 4 depolarization (the funny current, If).
- Arrhythmia mechanisms: reentry (most clinical tachycardias), abnormal or enhanced automaticity, and triggered activity (early and delayed afterdepolarizations).
- Reentry needs two pathways, unidirectional block and slow enough conduction for recovery ahead of the wavefront.
- Decremental conduction (delay lengthening as the coupling interval shortens) is typical of the AV node; most accessory pathways conduct without decrement.
Flashcards
Exam tip: When a tracing question gives you intervals, compare each to normal first. Usually only one is abnormal, and it points to the answer.
3. Pharmacology
Domain 3 (6%): antiarrhythmic drug classes and kinetics, anticoagulation, IV sedation and reversal agents in the EP lab, drug-device interactions and drug effects on rhythm and conduction.
Key facts
- Vaughan Williams: class I sodium channel blockers (IA procainamide, IB lidocaine, IC flecainide), class II beta blockers, class III potassium channel blockers (amiodarone, sotalol, dofetilide, ibutilide), class IV calcium channel blockers.
- Isoproterenol speeds conduction and shortens refractoriness to make arrhythmias inducible during EP studies.
- Adenosine causes transient AV nodal block; it can unmask atrial flutter or atrial tachycardia and terminate AV node-dependent SVT.
- During left atrial ablation, heparin is commonly titrated to an ACT above 300 seconds; protamine reverses heparin.
- Naloxone reverses opioids and flumazenil reverses benzodiazepines.
- In pre-excited AF, avoid AV nodal blockers (verapamil, diltiazem, digoxin, beta blockers, IV amiodarone); use cardioversion, procainamide or ibutilide.
Flashcards
Exam tip: Know one or two examples per drug class and the single most important side effect of each (for example QT prolongation with class III).
Test yourself on these topics
Take the free 15-question CEPS test, then save your results to unlock your Readiness Score and the mistakes bank.
4. Clinical Assessment and ECG
Domain 5 (8%): cardiac history and physical assessment, diagnostic tests (tilt table, monitors, stress, echo, MRI/CT), 12-lead ECG interpretation and localization, and inherited arrhythmia syndromes.
Key facts
- WPW pattern: short PR, delta wave and wide QRS from pre-excitation. WPW syndrome adds tachyarrhythmia.
- Typical flutter: negative sawtooth flutter waves in II, III and aVF with positive waves in V1 (counterclockwise).
Flashcards
Exam tip: For 12-lead questions, decide the QRS width and regularity first, then look for P waves and their relationship to the QRS.
5. Laboratory Considerations and Safety
Domain 6 (10%): equipment and connections, patient preparation, vascular, transseptal and epicardial access, recording and signal acquisition, consent and documentation, sterile technique, radiation and electrical safety, and managing complications.
Key facts
- Radiation: time, distance and shielding (ALARA). Doubling the distance cuts scatter dose to a quarter; low-frame-rate fluoroscopy and collimation reduce dose further.
- Lead aprons and thyroid collars protect staff; dosimeters track personal exposure.
Flashcards
Exam tip: Complication questions reward the first correct step. Confirm the diagnosis fast (echo, pressure) and alert the physician.
6. Invasive EP Study and Ablation
Domain 7 (30%, the largest): EP study indications, baseline intervals, refractory periods, programmed and differential pacing, SVT and VT evaluation, entrainment, ablation targets, 3D mapping, LAA occlusion and pediatric considerations.
Key facts
- Typical AVNRT: slow-fast circuit, very short VA interval (under about 70 ms), earliest atrial activation at the septum near the His.
- Orthodromic AVRT: antegrade down the AV node, retrograde up an accessory pathway; VA interval over about 70 ms, eccentric atrial activation with a left free-wall pathway.
Flashcards
Exam tip: Build a one-page table of SVT maneuvers and what each result means. It's the highest-yield sheet for the largest domain.
7. Devices, Imaging and Research
Domains 8, 9 and 10 (together about 15%): pacemaker and ICD basics, implant indications and troubleshooting, catheter and device positions on TTE, TEE, ICE, fluoroscopy and X-ray, and clinical trial methods and statistics.
Key facts
- Primary-prevention ICD (2017 AHA/ACC/HRS, Class 1): ischemic cardiomyopathy with LVEF 35% or less, NYHA II or III, at least 40 days post-MI and 90 days post-revascularization, on GDMT.
- Pacemaker timing basics: lower rate interval, AV delay, PVARP; mode switching in AF.
Flashcards
Exam tip: Research questions are mostly quick arithmetic: ARR, RRR and NNT. Don't confuse relative with absolute risk reduction.
How to pass
- Invasive EP is 30% of the exam. Be fluent with intracardiac intervals, refractory periods, entrainment and the SVT maneuvers that separate AVNRT, AVRT and atrial tachycardia.
- Learn the normal values: AH about 55 to 125 ms, HV 35 to 55 ms. Many tracing questions turn on one abnormal interval.
- Each of the 4 sections has a hard time limit and you can't go back. Don't bank time for later sections; it doesn't carry over.
- Use the on-screen calipers on every tracing question to check regularity and the timing of A and V, rather than eyeballing.
Frequently asked questions
How long should I study for the CEPS exam?
Most working candidates need 4 to 8 weeks at 45 to 60 minutes a day. Book your exam once your Readiness Score has stayed at 80 or higher for about a week.
Can I take the CEPS exam online?
IBHRE lists only in-person delivery at PSI test centers in North America and internationally; it doesn't list a remote option. Format: closed book, computer-based (on-screen calculator and calipers provided). Check IBHRE's current exam information for the rules.
What score do I need to pass the CEPS exam?
Not published. IBHRE sets a criterion-referenced cut score and reports a scaled score; practise to 75% or higher. The exam has 200 multiple-choice questions (180 scored) in 4 timed sections and a time limit of 4 hours (240 minutes), with 6-minute breaks between sections; you can't return to a finished section.
What are the most tested topics?
The outline covers physics, anatomy and physiology, fundamentals of electrophysiology, pharmacology, clinical assessment and ecg, laboratory considerations and safety, invasive ep study and ablation, devices, imaging and research. Use the free practice test to see which ones you need most.
The premium CEPS study path
Premium CEPS 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.
Your step-by-step study path
- 1Physics, Anatomy and Physiology9 key notes, 115 flashcards, then 450 practice questions in 18 sets of 25Notes free with an account
- 2Fundamentals of Electrophysiology9 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25Premium
- 3Pharmacology9 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25Premium
- 4Clinical Assessment and ECG9 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25Premium
- 5Laboratory Considerations and Safety8 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25Premium
- 6Invasive EP Study and Ablation8 key notes, 115 flashcards, then 425 practice questions in 17 sets of 25Premium
- 7Devices, Imaging and Research8 key notes, 110 flashcards, then 425 practice questions in 17 sets of 25Premium
- Final step: 6 full mock exams200 questions each, timed like test day. Pass them, then book your exam.Premium
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- 3,000 practice questions + 6 full mock exams per exam
- 800 flashcards + 60 key notes per exam, by topic, plus mind maps
- Spaced repetition + mistakes bank
- Readiness Score & detailed reports
- Video lessons as they release
- Content updates during your access
- 5 bonuses: timing and values sheet, malfunction atlas, study planner and more
- Pass Guarantee: complete the prep, pass or 100% back
Renews once a year until you cancel. We email you before each renewal. Cancel any time from your account; you keep access until the end of the year you've paid for.
Summarized from IBHRE's official candidate information and the rules cited, checked November 2026. Confirm current requirements with International Board of Heart Rhythm Examiners (IBHRE).