CRAT - Certified Rhythm Analysis Technician Pacemaker Rhythm Analysis Questions and Answers

Question 1

A CRAT observes a rhythm strip where a pacemaker spike is visible, but it is not followed by a P wave or a QRS complex.
This occurs intermittently throughout the strip.
What pacemaker malfunction does this represent?

Accepted Answer

Failure to capture

Answer

Undersensing

Answer

Oversensing

Answer

Normal pacemaker function

Question 2

Which of the following ECG characteristics is the hallmark of a normally functioning ventricular-paced rhythm?

Accepted Answer

A wide, bizarre QRS complex preceded by a pacing spike.

Answer

A narrow QRS complex preceded by a pacing spike.

Answer

A pacing spike following every T wave.

Answer

The absence of pacing spikes when the intrinsic rate is high.

Question 3

A patient's intrinsic heart rate is 50 bpm. Their pacemaker is programmed with a lower rate limit of 60 bpm, but no pacing spikes are visible on the ECG strip. This observation is most consistent with which pacemaker issue?

Accepted Answer

Failure to pace (failure to fire)

Answer

Failure to capture

Answer

Undersensing

Answer

Pacemaker-mediated tachycardia

Question 4

A technician is analyzing a rhythm strip and notes pacing spikes that appear at a fixed rate, with some spikes falling directly on the patient's own native QRS complexes and T waves. This indicates the pacemaker is not recognizing the patient's intrinsic rhythm. What is this malfunction called?

Accepted Answer

Undersensing

Answer

Oversensing

Answer

Failure to capture

Answer

Fusion beat

Question 5

A patient with a DDD pacemaker has an underlying sinus bradycardia. The ECG shows a pacing spike immediately followed by a P wave, which is then followed by a second pacing spike and a wide QRS complex. This pattern repeats consistently. What is the correct interpretation?

Accepted Answer

AV sequential pacing

Answer

Ventricular pacing only

Answer

Failure to sense the atrium

Answer

Atrial pacing with intact AV conduction

Question 6

A CRAT notices on a patient's monitor that the pacemaker intermittently stops firing, causing long pauses, especially when the patient moves their arm or coughs. The technician suspects the pacemaker is incorrectly identifying muscle artifact as cardiac signals. This malfunction is known as:

Accepted Answer

Oversensing

Answer

Failure to capture

Answer

Crosstalk

Answer

Undersensing