BHRS Certification - Exam

The Examination

The examination was first introduced in 1999 as part of the BPEG Certificate of Competency.  In 2006 the examination became the Heart Rhythm UK Certificate of Accreditation and structure of the examination was revised, with the introduction of core and specialist sections.

In 2011, the examination paper was marked electronically for the first time.  Since then, the questions and candidates responses have been evaluated in detail so that we can continue to improve the quality, relevance and validity of the questions.

In 2013, the number of questions was increased to 120 (60 core and 60 specialty), in part, to bring the examination into line with the EHRA examination.  As a consequence, the duration of the examination was increased to 4 hours.  Also in 2013, we introduced a third “clinical” specialist section.  This section is aimed at nurses with a special interest in CRM and is complimented by a new “logbook equivalent” of case discussions. It was not felt appropriate that nurses with a special interest in CRM complete a logbook, instead there is a requirement to complete a number of case studies.


Exam overview presentation: “BHRS certification: An overview”
Exam Question Breakdown 2017 for each paper (see below)
FAQs section
Exam Terms & Conditions sheet
Exam answer sheet/marking sheet guidance
Updated syllabus and recommended reading list
Sample exam questions
Link to HRC (Heart Rhythm Congress) course talks 
If you still have a query, please contact us at for all exam / logbook queries


2018 Exam

Registration will be open from the first (working) week in January 2018 for the 2018 Exam. The date of the exam has been confirmed as Friday 16 March 2018.


Certification Exam Pass Marks

Please note, pass marks vary slightly from examination to examination to take account of the relative difficulty of examinations presented to candidates, ensuring that the pass standard remains constant. 

The pass mark is determined by a 'standard setting' process. 

For example, in 2016, 136 candidates sat the Core section with the vast majority passing.  The median mark is shown below for each section of the 2016 exam.  Please note the median mark IS NOT the pass mark.

Core       57%   n=136
Devices  57%   n=133
EP          58%   n=10
Clinical   55%   n=5

All candidates who reach the required standard for the appropriate exam will pass, however it has been and continues to be the decision / policy of the BHRS Council not to disclose the actual pass mark or to enter discussions with individual candidates about their marks / examination performance.

Further details about the BHRS exam can be found in the below presentation available to download


Exam Question Breakdown 2017

Section 1: Core

Core Sub-Sections Number of Questions
1.1 Anatomy/Physiology/Clinical Assessment 8
1.2 Arrhythmias - Diagnosis/ECGs 10
1.3 Devices (Inc. clinical trials)  15
1.4 Electrophysiology (Inc. clinical trials) 15
1.5 Guidelines/DVLA/MHRA 6
1.6 Pharmacology 6

Section 2: Devices

Devices Sub-Sections Number of Questions
2.1 Pacemaker biophysics & physiology 7
2.2 Device indications & modes 10
2.3 Pacemaker follow-up, troubleshooting, CXR 15
2.4 Cardiac Resynchronisation Therapy 10
2.5 Implantable Cardioverter Defibrillators 10
2.6 ECGs/Infection/Lead extraction/ILR 8

Section 3: Electrophysiology

EP Sub-Sections Number of Questions
3.1 Basic EP (genetics, channels, drugs, clinical) 10
3.2 General concepts: Catheter position, access, signals, filter-setting.  Intervals, block/gap, Arrhythmia mechanism - Pacing manoeuvres 10
3.3 Invasive electrophysiology - standard atrial arrhythmias (SVT, typical flutter) 15
3.4 Invasive electrophysiology - complex atrial arrhythmias (AF, atypical flutter, atrial tachycardia) 10
3.5 Invasive electrophysiology - complex ventricular arrhythmias (scar related, non-scar related, PVCs) 10
3.6 Invasive electrophysiology - Specific ablation aspects: lesion formation, energy sources.  Complications & Imaging mapping systems 5

Section 4: Nursing/Clinical

Nursing Sub-Sections Number of Questions
4.1 Clinical assessment/Guidelines 10
4.2 Arrhythmias - Diagnosis/Mechaniss/ECG 15
4.3 Pharmacology 10
4.4 Syncope diagnosis and treatment 5
4.5 Devices (Pacemaker/CRT/ICD) 10
4.6 Electrophysiology 10


Exam Syllabus and Reading List

Please click here to download the syllabus.  A recommended reading list is also available for download by clicking here.

Sample Exam Questions

For any potential candidate considering taking the exam in the future, you may find it useful to view the below representative questions for the devices and EP sections:


Exam Answer Sheet Guidance

Since 2011, the examination papers have been marked electronically. This allows British Heart Rhythm Society to be able to examine the questions and candidates responses in more detail, so that we can work to improve the quality and validity of the questions. It is therefore essential that candidates are aware of how they are required to mark their answers on the exam answer sheets. Please click here to download the guidance.