Certified Rhythm Analysis Technician (CRAT)

Requires: Passing the one-part Certified Rhythm Analysis Examination

Who should apply: Professionals who utilize specilized monitoring equipment to analyze cardiac rhythms.  

Specialty Examination Fee: $160

CRAT Navigation

All applicants must meet the following criteria:

1. Have a high school diploma or general education diploma at the time of application.

2. Fulfill one (1) of the qualifications of the exam for which you are applying. See qualifications listed in the tables below.

3. Provide typed documentation to support the qualification under which you are applying. Required documentation for each qualification is listed below. CCI reserves the right to request additional information.

Changes to the qualification criteria have been made and will be effective for applicants submitting their applications on or after July 1, 2013. To review the revised qualifications, please visit www.cci-online.org or contact CCI headquarters.

Qualification Prerequisite # Qualification Prerequisite Supporting Documentation
CRAT1 Currently enrolled as a student or a graduate of a cardiovascular or allied health training program.

Completion certificate


Student Verification Letter


Educational Transcripts

CRAT2 Currently employed or previously employed in the field of Cardiovascular Technology or in a recognized allied health field (recognized by the American Medical Association (AMA)). Employment Verification Letter (Should be not older than six months from the date the application is received at CCI Headquarters)
CRAT3 Completed requirements for a graduate or undergraduate degree from a recognized institution in a field related to science or OR physical health.

Completion certificate a


Student Verification Letter


Educational Transcripts

CRAT4 Volunteer service in the field of Cardiovascular Technology for a minimum of two (2) years and documentation supporting full-time technical activities for a two (2) year period. Employment Verification Letter (Should be not older than six months from the date the application is received at CCI Headquarters)

Click here for sample Student Verification Letter and Employment/Volunteer Verification Letter. 

CCI requires the Student Verification Letter contain the following:

1) Educational program’s original, official letterhead or stationery.
2) Indicate the date the letter was signed by educational director.
3) Indicate the name of the applicant.
4) Indicate full- or part-time student.
5) Indicate the date or expected date of graduation.
6) Indicate the specialty of the educational program.
7) Original signature of direct supervisor or employer.

CCI requires the Employment/Volunteer Verification Letter contain the following: 

1) Employer’s original, official letterhead or stationery.
2) Indicate the date the letter was signed by employer/supervisor.
3) Indicate the name of the applicant.
4) Indicate full- or part-time employment.
5) Indicate the time period of employment.
6) Indicate the primary duties of applicant, related to the field of cardiovascular technology.
7) Original signature of direct supervisor.

Exam Overview Friday, February 04th 2011 11:01 AM

The examination matrix is provided to illustrate the general distribution of questions and the relative weight or emphasis given to a skill or content area on the examination.

Content Category

Complying with Governing Regulations

Interacting with Patients and Others

Identify Normal ECG Components and Cardiac Anatomy

Determine patient's cardiac rhythm

Troubleshoot ECG

Compile ECG Results


Approx. % of Exam








The list below describe general areas of knowledge that are needed in order to perform the tasks identified. This knowledge will apply across multiple tasks.

Regulatory and Compliance Standards

(e.g. OSHA, HIPAA, informed consent, medical records)

Communication with staff and faculty

Cardiac rhythm analysis and interpretation

Medical ethics

Patient safety

ECG troubleshooting

Communication with the client

Emergency response

Documentation of findings


Basic Cardiovascular anatomy and physiology

Medical terminology

 The task list below describes the activities which a Cardiographic Technician is expected to perform on the job. All examination questions are linked to these tasks.

     Duties and Tasks  % of Exam

Complying with Governing Regulations

  1 Obtain/maintain prescriptions/orders  
  2 Maintain HIPAA compliance  
  3 Obtain patient demographics  
  4 Verify patient identification  

Interacting with Patients and Others

  1 Familiarize patients regarding services  
  2 Educate patients on when to call for help  
  3 Educate patients on electrical hazards, broken wir  
  4 Obtain patient symptoms, activities, location  
  5 Service cardiac patients (customer service)  
  6 Communicate with ordering physician or physician's office  
  7 Communicate with patients' family members  

Communicate with other offices (scheduling, order erification, etc.)

  9 Seek advice regarding findings  
  10 Conduct inter-departmental interactions  
C   Identify Normal ECG Components and Cardiac Anatomy  19%
  1 Identify P-wave  
  2 Identify and measure the PR interval  
  3 Identify and measure a QRS complex  
  4 Identify T-wave  
  5 Identify the standards for ECG recording.  
  6 Calculate the atrial rate  
  7 Calculate the ventricular rate  
  8 Identify the relationship of the atrial and ventricular rates  
  9 Evaluate P-P and R-R interval regularity  
  10 Identify the chambers of the heart  
  11 Identify the valves of the heart  
  12 Identify the conduction system of the heart  
D    Determine patient's cardiac rhythm  55%
  1  Identify Sinus Rhythm  
    a Identify normal sinus rhythm.  
    b Identify sinus arrhythmia.  
    c Identify sinus tachycardia.  
    d Identify sinus bradycardia.  
    e Identify sinus arrest  
  2  Identify Atrial Rhythm  
    a Identify wandering atrial pacemaker.  
    b Identify rhythms with premature atrial ectopy (PAC, Couplets, Triplets, Runs, Multifocal)  
    c Identify atrial tachycardia.  
    d Identify supraventricular tachycardia  
    e Identify atrial fibrillation (general characteristics)

1 Identify atrial fibrillation with a slow ventricular response.

2 Identify atrial fibrillation with a rapid ventricular response.
    f Identify atrial flutter.

1 Identify atrial flutter with a ratio of ventricular response.

2 Identify atrial flutter with a variable ventricular response.
  3  Identify Junctional Rhythm  
    a Identify rhythms with premature junctional ectopy  
    b Identify junctional escape rhythms.  
    c Identify accelerated junctional rhythms.  
    d Identify junctional tachycardia.  
  4  Recognize Ventricular Rhythms  
    a Identify rhythm with premature ventricular ectopy (PVCs, Couplets, Triplets)  
    b Identify idioventricular rhythms (agonal, escape, and accelerated)  
    c Identify ventricular tachycardia.  
    d Identify ventricular fibrillation.  
    e Identify ventricular standstill  
  5 Recognize Asystole  
  6 Recognize Conduction Defects  
    a Identify First Degree AV block  
    b Identify second degree type one AV block.  
    c Identify second degree type two AV block.  
    d Identify third degree AV block

1 Identify third degree AV block with a junctional escape rhythm (narrow QRS)

2 Identify third degree AV block with a ventricular escape rhythm (wide QRS)
    e Identify presence of intraventricular conduction delay (Bundle Branch Block)  
  7 Determine paced events  
    a Identify paced atrial rhythm  
    b Identify paced ventricular rhythm  
    c Identify AV sequential (atrioventricular) paced rhythm  
    d Identify P-wave synchronous, ventricular paced rhythm  
    e Identify loss of pacing capture.  
    f Identify loss of sensing  
    g Identify failure to pace  
E    Troubleshoot ECG  6%
  1  Recognize artifact on ECG tracings.  
     a Recognize artifact on ECG tracings from wandering baseline  
     b Recognize artifact on ECG tracings from somatic tremor, patient movem  
     c Recognize artifact on ECG tracings from EMI/60 cycle interference  
  2  Identify inappropriate electrocardiograph paper speed  
  3  Identify inappropriate gain of the ECG signal  
  4  Identify causes of artifact  
  5  Identify lead reversals  
F    Compile ECG Results  5%
  1  Insert preliminary findings  
  2  Compare test results to past tests  
  3  Respond if notification criteria are met (Dispatch EMS if needed)  
  4  Correlate findings with patient symptoms or risk  
  5  Create patient report  
    TOTAL  100%

Sample Questions

1. Somatic tremor artifact may be caused by:
a. Switching leads
b. Circuit overload
c. Defective machine
d. A cold, uncomfortable environment

2. Which of the following arrhythmias may lead to death if asynchronous counter shock is not available?
a. Atrial tachycardia and atrial flutter
b. Atrial fibrillation and bundle branch block
c. Sinus tachycardia and wandering pacemaker
d. Ventricular fibrillation

3. Ventricular repolarization occurs during the ______ wave on the ECG.
a. P wave
b. T wave
c. P-R interval
d. QRS complex

4. Which waves and/or lines on the standard EKG measuring greater than 0.12 seconds may be indicative of a bundle branch block?
a. P waves
b. PR intervals
c. QRS complexes
d. ST segments

1. d 2. d 3. b 4. c

The textbooks listed in the following section are intended as a recommended resource when preparing for examination. Any general text related to the content on the examination may be used. It is not necessary to use all of the texts identified. They are provided as suggestions only. CCI does not endorse nor recommend any third party review course or material.

1. Rapid Interpretation of EKG’s, 6th Edition, Dubin, Dale, 2000.
2. Cardiac Pacing and ICD’s , 5th Edition, Ellenbogen, K.A. & Wood, 2008.
3. Cardiac Pacing and Defibrillation: A Clinical Approach, 1st Edition, Hayes, Lloyd, Freedman, 2000.
4. ECG Interpretation Made Incredibly Easy, 2nd Edition, Springhouse, 2002.
5. Cardiac Pacemakers Step by Step: An Illustrated Guide, Barold, S. Serge, Stroobandt, Roland X., Sinnaeve, Alfons F., 2006
6. ECG Workout: Exercises in Arrhythmia Interpretation, 5th Edition, Huff, Jane, 2006.
7. Pocket Guide to Basic Dysrhythmias: Interpretation & Management, 3rd Edition, Rev., Huszar, Robert J., 2007.
8. The Art of EKG Interpretation: A Self-Instructional Text, 6th Edition, Ehrat, Karen S., 2005.
9. The Complete Study Guide to Learning the Electrocardiogram, 1st Edition, Martin, Douglas, 2007
10. The Nuts and Bolts of Cardiac Pacing, Kenny, Tom, 2007
11. The Complete Guide to Ambulatory Cardiac Monitoring and Full Disclosure Telemetry, S. L. Kotar, J.E. Gessler, 2010.

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