RCES Study Guide: What to Learn, in the Proportions CCI Tests It

The organising principle

Everything in this guide follows one rule: weight your study time to the blueprint, not to your interests.

That sounds obvious and almost nobody does it. Ablation is the fun part of EP and it is 21% of the exam. Post-procedural care is the part everyone assumes they already know and it is 8% — roughly twelve scored questions, which is more than enough to be the difference between 640 and 660.

Domain weights are CCI’s published figures. The question counts in the third column are simple arithmetic applied to the 150 scored items for planning purposes — CCI does not publish a per-domain question count, and the actual distribution on your form may differ. Use them to allocate study hours, not to predict your exam.

Intra-procedural activities — 36%

The largest bucket by a wide margin, and the one where clinical familiarity most often masks conceptual gaps. This is the case itself: access, catheters, the recording system, mapping, imaging, monitoring, and safety.

What to know cold

• Catheter stations and what each one records. High right atrium, His bundle, coronary sinus, RV apex — not just where they sit, but what signal each yields and what a bad signal looks like.
• The Triangle of Koch and its borders, and why they matter for both His recording and AV nodal ablation risk.
• The recording and stimulation system. Signal acquisition, high- and low-pass filtering and what each filter does to an electrogram, gain, and the stimulus generator.
• Interval measurement. PA, AH, and HV — where each is measured from and to, normal ranges, and what a prolonged or short value implies.
• 3D electroanatomic mapping as a concept. Activation mapping, voltage mapping, propagation, and the difference between anatomic and electrical accuracy. Vendor-neutral.
• Intracardiac echo and fluoroscopy, including the standard views and what each is used to confirm.
• Transseptal puncture and the fossa ovalis as a target.
• Radiation safety. Time, distance, shielding, scatter, dose measurement, and ALARA in practice.
• Troubleshooting. Impedance changes, noise, oversensing, catheter dislodgement, loss of capture.

Where people lose points

Filtering. Almost everyone who works in an EP lab can operate the system; far fewer can say what happens to a far-field signal when you raise the high-pass filter, and that distinction is exactly what a well-written question probes.

Diagnostic procedures — 26%

The EP study itself: baseline measurements, programmed stimulation, induction, and working out what the arrhythmia actually is.

What to know cold

• Baseline conduction intervals and their normal ranges.
• Programmed electrical stimulation protocols — drive trains, extrastimuli, decremental pacing, and what each manoeuvre is designed to reveal.
• Refractory periods. ERP, FRP, RRP, and the difference between atrial, AV nodal, and ventricular measurements.
• Dual AV nodal physiology and the AH jump.
• Differentiating the SVTs. AVNRT versus AVRT versus atrial tachycardia — the diagnostic manoeuvres and what each result rules in or out.
• Accessory pathways. Kent bundles, pre-excitation and the delta wave, concealed versus manifest, and localisation.
• Entrainment — the criteria, post-pacing interval, and what concealed entrainment tells you.
• Wide-complex tachycardia differentiation — VT versus SVT with aberrancy.
• Sinus and AV node function testing, including sinus node recovery time and Wenckebach cycle length.
• Heart block localisation — above, within, or below the AV node, and why it changes management.

Where people lose points

Manoeuvre interpretation. Knowing that ventricular overdrive pacing helps distinguish AVNRT from AVRT is table stakes; being able to reason from a specific post-pacing interval or V-A-V versus V-A-A-V response to a diagnosis is what is actually tested.

Therapeutic procedures — 21%

Ablation and device implantation support.

Ablation

• Energy sources — radiofrequency, cryoablation, and pulsed-field — and the mechanism, lesion characteristics, and distinct risk profile of each.
• Targets by arrhythmia: slow-pathway modification for AVNRT, accessory-pathway ablation, cavotricuspid isthmus for typical flutter, pulmonary-vein isolation for AF, substrate and exit-site approaches for VT.
• Endpoints. Entrance block, exit block, non-inducibility, and why each is or is not sufficient.
• Complication anatomy. Atrioesophageal fistula, phrenic nerve injury, AV block during septal ablation, tamponade.
• The vein of Marshall and other epicardial connections.

Device therapy

• Pacemaker, ICD, and CRT indications and system components; single, dual, and biventricular configurations.
• Lead placement and testing — pacing thresholds, sensing amplitudes, impedance values, and what an out-of-range number means.
• DFT testing and current practice around it.
• Pacing modes and the NBG code; AV and VV delay optimisation.
• Tiered therapy programming for ICDs — detection zones, ATP, shock therapy.
• Conduction system pacing — His bundle and left bundle branch area pacing.
• Troubleshooting — undersensing, oversensing, failure to capture, subclavian crush, lead extraction considerations.

Pre-procedural activities — 9%

Small domain, easy points, routinely skipped.

• Antiarrhythmic management around the case — the Vaughan Williams classes and washout logic before an EP study.
• Anticoagulation strategy and reversal agents, including andexanet alfa, protamine, and 4F-PCC.
• Sedation planning and the agents used — midazolam, fentanyl, and their reversal agents flumazenil and naloxone.
• Labs, NPO status, and informed consent.
• Baseline 12-lead ECG review and what it predicts about the study.
• The universal protocol time-out.

Post-procedural activities — 8%

The smallest domain and the most under-studied. Roughly a dozen scored questions sitting there for anyone willing to spend two evenings on it.

• Access-site management — manual compression, closure devices, and hemostasis endpoints.
• Complication surveillance: tamponade, pneumothorax, retroperitoneal hematoma, pseudoaneurysm, AV fistula, phrenic nerve injury.
• Device interrogation and programming before discharge; MRI-conditional device considerations.
• Patient education — activity restrictions, wound care, what to report.
• Documentation and handoff.

An 8–12 week schedule

Week 0 — Diagnose before you plan

Do not build a schedule before you know your baseline. Sit a scored diagnostic, get a domain breakdown, and let it tell you where the 8–12 weeks should be spent. Skipping this step is how people spend six weeks re-drilling the thing they were already good at. If you want this sequence laid out on a calendar, the 8-week RCES study plan does exactly that.

Weeks 1–2 — Foundations

• Conduction system anatomy, cardiac action potentials, and arrhythmia mechanisms (reentry, automaticity, triggered activity)
• Surface ECG and intracardiac electrogram basics; normal intervals and how they are measured
• SA node, AV node, and bundle branch anatomy and blood supply

Weeks 3–6 — The 83%

• Catheter stations and recording sites until the anatomy is automatic
• The recording and stimulation system; filtering, gain, interval measurement
• 3D mapping concepts; activation and voltage maps
• The EP study: stimulation protocols, induction, SVT differentiation
• Ablation energy sources and targets by arrhythmia
• Device implant support, lead testing, and programming

Weeks 7–8 — Pharmacology, safety, and the bookends

• Antiarrhythmics, anticoagulation, sedation, and reversal agents
• Radiation safety, sterile technique, intra-procedural monitoring
• Pre- and post-procedural domains in full — the cheap 17%

Weeks 9–12 — Mocks and gap-closing

• Full-length, timed, blueprint-matched mock exams under test conditions
• Review every missed question until you can explain why the right answer is right and why each wrong answer is wrong
• Re-drill your two weakest domains in the final week; do not start new material

The study habits that actually move the needle

From watching a lot of people through this process, four things separate a comfortable pass from a retake, and none of them are about how many hours you put in.

• Retrieval over review. Re-reading a chapter feels productive and is close to worthless. Answering a question about it, wrong, and then finding out why, is what builds durable recall.
• Explain the distractors. If you cannot say why option C is wrong, you have not learned the item — you have recognised option B. Recognition is the first thing to fail under exam pressure.
• Spaced, not massed. Six sessions of forty minutes across two weeks beats one four-hour Sunday. This is one of the most robust findings in learning research and almost nobody applies it voluntarily.
• Timed full-length rehearsal, at least twice. Three hours of sustained accuracy is a trained capacity. Find out where your stamina fails on a practice day, not on exam day.

What to study from

An honest word: we make a product in this space, so read the following knowing that. We have set out the broader landscape, including our competitors, on best RCES exam prep 2026.

Whatever you choose, a workable RCES kit has three parts:

1. A content resource that explains mechanisms, not just facts. Books, courses, or an app — the format matters less than whether it answers “why.”
2. A question bank large enough that you are not memorising the items, with worked explanations. Questions without explanations are a test, not a study tool.
3. Full-length, blueprint-matched mock exams. This is the part most people skip and the part most predictive of readiness.

Cardiac Codex is built to be all three in one place — 179 lessons, 2,198 practice questions with worked explanations, four full-length blueprint-matched mock exam forms (two RCES and two RCIS), spaced flashcards, mastery tracking, and Cardiac Coach, an AI tutor grounded in the same curriculum. You can judge the quality without paying: the 25 free RCES questions and the free diagnostic are genuinely free.

RCES study FAQ

Keep reading