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Which structure is normally the dominant pacemaker of the heart in a healthy adult at rest?

Atrioventricular (AV) node

Sinoatrial (SA) node

Bundle of His

Purkinje fibers

to track

2026 Statistics

Key Facts: CRAT Exam

100

Free CRAT Practice Questions

OpenExamPrep CRAT bank

~130

Items on CRAT Exam

CCI exam application (verify current count)

0.04 s

Small Box at 25 mm/s

Standard ECG paper convention

0.12-0.20 s

Normal PR Interval

Standard ECG criteria

≥1 mm

STEMI ST Elevation in 2 Contiguous Limb Leads

ACC/AHA STEMI criteria

3 years

CCI Credential Validity

CCI renewal policy

ANSI/ISO 17024

CCI Accreditation

CCI accreditation

CRAT is a knowledge-based, multiple-choice exam from Cardiovascular Credentialing International (CCI), an ANSI/ISO 17024-accredited credentialing body. Candidates must hold a high school diploma plus one of several accepted routes (1 year of rhythm-analysis work experience, completion of a clinical rhythm program, current CCI/ARDMS/NBSTSA credential, or current healthcare licensure). Content emphasizes rhythm recognition, ECG basics (25 mm/s paper, 0.04 s small box, 10 mm/mV calibration), sinus/atrial/junctional/ventricular/AV-block/pacemaker patterns, basic STEMI lead localization, alarm management, and CRAT scope of practice. The credential is valid for 3 years.

Sample CRAT Practice Questions

Try these sample questions to test your CRAT exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which structure is normally the dominant pacemaker of the heart in a healthy adult at rest?

A.Atrioventricular (AV) node

B.Sinoatrial (SA) node

C.Bundle of His

D.Purkinje fibers

Explanation: The SA node, located at the junction of the superior vena cava and right atrium, is the heart's dominant pacemaker, firing at an intrinsic rate of 60-100 bpm. It depolarizes spontaneously through If (funny) current activation and sets the rhythm for the rest of the conduction system.

2What is the intrinsic firing rate of the AV junction when it acts as an escape pacemaker?

A.20-40 bpm

B.40-60 bpm

C.60-100 bpm

D.100-150 bpm

Explanation: The AV junction (AV node and proximal Bundle of His) has an intrinsic escape rate of 40-60 bpm. When the SA node fails or is blocked, the AV junction takes over, producing a junctional escape rhythm at this rate.

3Which phase of the cardiac action potential corresponds to the absolute refractory period when the cell cannot be re-stimulated regardless of stimulus strength?

A.Phase 0 (depolarization) through early phase 3

B.Phase 4 (resting)

C.Late phase 3 only

D.Phase 2 plateau alone

Explanation: The absolute refractory period spans from phase 0 depolarization through approximately the first half of phase 3 repolarization, when fast sodium channels are inactivated. During this window the myocyte cannot generate another action potential at any stimulus strength, protecting the heart from re-entrant arrhythmias during early repolarization.

4Sympathetic nervous system stimulation of the heart primarily produces which effect on conduction and rate?

A.Decreased SA node firing and prolonged AV conduction

B.Increased SA node firing and faster AV conduction

C.No effect on heart rate but slowed conduction

D.Heart block at the AV node

Explanation: Sympathetic stimulation, mediated by norepinephrine acting on beta-1 adrenergic receptors, increases SA node automaticity (positive chronotropy) and accelerates AV nodal conduction (positive dromotropy). This is why exercise, fear, or pain increase heart rate and shorten the PR interval.

5On standard ECG paper running at 25 mm/s, one small (1 mm) box represents how much time?

A.0.02 seconds

B.0.04 seconds

C.0.10 seconds

D.0.20 seconds

Explanation: At the standard paper speed of 25 mm/s, each small (1 mm) box equals 0.04 seconds (40 ms). Five small boxes form one large (5 mm) box, which represents 0.20 seconds. These two values anchor every interval and rate calculation in rhythm analysis.

6A standard ECG calibration mark is 10 mm tall. What voltage does this represent?

A.0.5 mV

B.1 mV

C.2 mV

D.10 mV

Explanation: Standard ECG calibration is 10 mm/mV, so a 10-mm-tall calibration box corresponds to 1 mV. Verifying calibration before interpretation prevents misreading low-voltage QRS or exaggerated voltage as LVH; half-standard (5 mm/mV) is sometimes used when QRS is too tall to fit the strip.

7When using the 6-second method to estimate heart rate on a rhythm strip, the technician counts:

A.QRS complexes in a 6-second strip and multiplies by 10

B.P waves in a 6-second strip and multiplies by 6

C.QRS complexes in 3 seconds and multiplies by 20

D.Large boxes between two QRS complexes and divides by 300

Explanation: The 6-second method counts QRS complexes within a 6-second strip (30 large boxes at 25 mm/s) and multiplies by 10 to estimate ventricular rate per minute. It is the preferred method for irregular rhythms such as atrial fibrillation, where the 1500/300 method gives unreliable results.

8Which limb leads form Einthoven's triangle and view the heart in the frontal plane?

A.Leads I, II, III

B.Leads aVR, aVL, aVF

C.Leads V1, V2, V3

D.Leads V4, V5, V6

Explanation: Einthoven's triangle is formed by the three standard bipolar limb leads I (right arm to left arm), II (right arm to left leg), and III (left arm to left leg). Lead II provides the best view of P waves and is the most commonly used continuous telemetry monitoring lead.

9On a 12-lead ECG, the V1 chest electrode is placed at which anatomic location?

A.Fourth intercostal space at the right sternal border

B.Fourth intercostal space at the left sternal border

C.Fifth intercostal space at the midclavicular line

D.Fifth intercostal space at the anterior axillary line

Explanation: V1 is placed at the fourth intercostal space immediately to the right of the sternum. V2 is at the fourth intercostal space at the left sternal border, V4 at the fifth intercostal space midclavicular line, V5 at the fifth intercostal space anterior axillary line, and V6 at the fifth intercostal space midaxillary line.

10On 5-lead bedside telemetry, the white electrode is placed at which location?

A.Right midclavicular line, just below the clavicle (right arm)

B.Left midclavicular line, just below the clavicle (left arm)

C.Right lower abdomen (right leg)

D.Fourth intercostal space at the right sternal border (chest)

Explanation: The standard mnemonic 'White on Right' places the white electrode on the right upper chest just below the clavicle at the midclavicular line (right arm). Black goes on the left upper chest, red on the left lower chest, green on the right lower chest, and the brown chest electrode in the V1 position.

About the CRAT Exam

CRAT (Certified Rhythm Analysis Technician) is CCI's credential for allied-health professionals whose primary role is recognizing cardiac rhythms on telemetry, monitoring patients on continuous ECG, and escalating dysrhythmias to the bedside care team. CRATs work in hospital telemetry units, central monitoring suites, and EP/cardiology departments.

Questions

130 scored questions

Time Limit

2 hours

Passing Score

Scaled passing score (set by CCI)

Exam Fee

$175 (Cardiovascular Credentialing International (CCI))

CRAT Exam Content Outline

~15%

Cardiac Anatomy, Physiology, and Conduction

SA node, AV node, His-Purkinje system, refractory periods, action potential phases, and autonomic (sympathetic/parasympathetic) modulation of rate and conduction.

~15%

ECG/Rhythm Strip Basics

Paper speed (25 mm/s), small box (0.04 s), large box (0.20 s), 10 mm/mV calibration, lead placement (Einthoven I/II/III, aVR/aVL/aVF, V1-V6), and 3-lead/5-lead/12-lead monitoring conventions.

~10%

Sinus Rhythms

Normal sinus rhythm criteria, sinus bradycardia, sinus tachycardia, sinus arrhythmia, sinus arrest, and sinus exit block — with appropriate escalation actions.

~15%

Atrial Rhythms

PACs, atrial flutter (sawtooth, 250-350/min), atrial fibrillation (irregularly irregular, no P waves), MAT (≥3 P morphologies, rate >100), and wandering atrial pacemaker.

~5%

Junctional Rhythms

Junctional escape (40-60 bpm), accelerated junctional (60-100 bpm), and junctional tachycardia (>100 bpm), including digoxin-related junctional ectopy.

~15%

Ventricular Rhythms

PVCs (uni/multifocal, bigeminy, R-on-T), monomorphic and polymorphic VT, torsades de pointes (and triggers), VF, idioventricular (20-40), accelerated idioventricular (40-100), agonal rhythm/asystole.

~10%

AV Blocks

First-degree AV block (PR >0.20 s), second-degree type I (Wenckebach), second-degree type II (Mobitz II), and third-degree (complete) AV block — with urgency criteria for pacing.

~5%

Pacemaker Rhythms

Atrial-paced, ventricular-paced, AV-sequential (DDD), biventricular CRT, and malfunction recognition (failure to capture, sense, output).

~5%

Acute Myocardial Ischemia / Infarction

STEMI thresholds (≥1 mm in 2 contiguous limb leads, ≥2 mm V2-V3 men ≥40), reciprocal changes, anterior/lateral/inferior/posterior lead localization, pericarditis differential.

~5%

Telemetry Monitoring, Alarms, and Escalation

AHA practice standards for ECG monitoring, TJC alarm management NPSG, false-alarm verification, SBAR handoff, HIPAA, and CRAT scope of practice (recognition + communication, not diagnosis or treatment).

How to Pass the CRAT Exam

What You Need to Know

Passing score: Scaled passing score (set by CCI)
Exam length: 130 questions
Time limit: 2 hours
Exam fee: $175

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CRAT Study Tips from Top Performers

1Memorize the timing rules: 25 mm/s paper, 1 small box = 0.04 s, 1 large box = 0.20 s, 10 mm/mV calibration

2Learn the conduction-system rates cold: SA node 60-100, AV junction 40-60, ventricular 20-40 — every escape rhythm follows these

3Drill rhythm recognition by criteria, not just shape: rate, regularity, P-wave presence/morphology, PR, QRS width, P:QRS ratio

4Practice STEMI lead localization: II/III/aVF inferior, V1-V4 anterior, I/aVL/V5/V6 lateral, V1-V3 reciprocal for posterior

5Know R-on-T as the key trigger for polymorphic VT and torsades — and recognize QT-prolonging drug classes (haloperidol, methadone, fluoroquinolones, sotalol)

6Master the AV block ladder: 1st (PR >0.20), 2nd type I Wenckebach (progressive PR), 2nd type II Mobitz (fixed PR with dropped QRS), 3rd (full P-QRS dissociation)

7Practice pacemaker spike interpretation: spike before P (atrial paced), spike before QRS (ventricular paced), two spikes (AV-sequential), spike with no capture (failure to capture)

8Always verify suspected lethal rhythms in a second lead before escalation, but never delay code activation when the patient is clearly unresponsive

Frequently Asked Questions

Who issues the CRAT credential?

CRAT is issued by Cardiovascular Credentialing International (CCI), an ANSI/ISO 17024-accredited credentialing body. CCI also issues CCT, RCS, RCIS, RVS, RPhS, and other cardiovascular credentials.

What does a Certified Rhythm Analysis Technician do?

CRATs work in central telemetry monitoring, hospital floors, and cardiology/EP units. They recognize cardiac rhythms on continuous ECG, document strips, and escalate dysrhythmias to the bedside RN, provider, or rapid response team. Diagnosis and treatment decisions remain with licensed providers.

What are the eligibility routes for CRAT?

Candidates must hold a high school diploma or equivalent AND one of the following: 1 year of full-time rhythm-analysis work experience; completion of an allied-health or clinical rhythm analysis program; a current CCI/ARDMS/NBSTSA/other accepted credential; or current healthcare licensure (RN, RT, EMT-P, LPN, MD/DO/PA/NP). Verify the current eligibility table in the CCI exam application before applying.

How is the CRAT exam scored?

CRAT uses a scaled passing score set by CCI. Specific thresholds and pretest item counts are published in the current CCI exam application; verify before sitting the exam.

How long is CRAT certification valid?

CCI credentials are typically valid for 3 years. Renewal is by continuing education credits or retesting per the CCI renewal handbook.

What is the difference between CRAT and CCT?

CRAT focuses on continuous rhythm analysis and telemetry monitoring. CCT (Certified Cardiographic Technician) covers a broader scope including 12-lead ECG, Holter, stress testing, and basic cardiac monitoring procedures. Many candidates pursue CRAT first and add CCT for career mobility.

Is CRAT recognized by hospitals?

Yes. Hospitals across the U.S. recognize CCI credentials; many telemetry and central-monitoring positions list CRAT as preferred or required, particularly in tertiary and academic centers. CCI is ANSI/ISO 17024-accredited, signaling rigorous credentialing standards.