BHRS Examination Guidance & Support Documents

In order to achieve BHRS Certification candidates must pass an 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.  It is a requirement that you must be a BHRS member to take the examination.

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.

The BHRS Examination is now approaching maximum capacity of 145. Any applications received after this will be placed on a reserve list. If you are placed on the reserve list you will be notified.

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2019 Exam Timings

  • Exam registration will open at 11:00 on Sunday 6 October (please make your way to the reception area of the ICC who will then direct you up the escalators to registration)

  • The exam will start promptly at 12:00 – any registrations after 11:50 will not be admitted

  • The exam will finish at 14:00 for anyone resitting one section or sitting a specialist section.

  • The exam will finish at 16:00 for all candidates – you are advised to spend 2 hours on the core section and 2 hours on either the Devices, EP or Clinical section.

  • The exam will finish at 17:00 for dyslexic candidates (if you need this extra time please email – evidence will need to be provided)

Instructions for 2019 Exam Candidates


BHRS Examination Details

Please be aware that from 2019 the BHRS written examination will be held as part of Heart Rhythm Congress. The exam will be held on the Sunday afternoon in Birmingham and this will be the only venue hosting the examination. Registration will open at the start of May.

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.  or 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.

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





No. of Qs

 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





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





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





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