This educational activity is certified by the American College of Cardiology Foundation
Imaging Case Series: Conduction System Abnormalities (Nuclear)


Avirup Guha, MBBS

Charles J. Hardebeck, MD, FACC

Gbemiga G. Sofowora, MBChB, FACC

Jason Evanchan, MD


Thomas M. Bashore, MD, FACC

Shawn A. Gregory Sr., MD, FACC


The overall goal of this CME certified, online activity is to be able to identify indications of nuclear stress testing, and recognize the patterns of artifacts caused by pacing and bundle branch blocks.


The American College of Cardiology Foundation (ACCF) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The ACCF designates this enduring material for a maximum of up to .25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

While offering CME credits noted above, this program is not intended to provide extensive training or certification in the field.

Target Audience

This activity is intended for cardiovascular physicians, adult physicians, and surgeons.

Important Dates

Date of Release: April 17, 2017

Term of Approval/Date of CME Expiration: April 17, 2018

Learner Objectives

After completing the activity, the learner will be better able to:

  • Select the appropriate stress protocol in patients with an underlying left bundle branch block or paced rhythm.
  • Recognize the perfusion defects seen on radionuclide myocardial perfusion imaging with a left bundle branch block and with right ventricular paced rhythms.
  • Discuss the pathophysiology of defects seen with left bundle branch block and with right ventricular paced rhythms.

Method of Participation and Claiming Credit

ACCF Case Vignettes feature case information and questions. To be eligible for credit, you must attain a score of 70% or better on the questions included in the activity.

Requesting AMA PRA Category 1 CME Credit™ for this Activity
To request credit, you must:

  1. Read all text and view all tables and/or figures in the case for which you wish to receive credit.
  2. Answer the questions in each case for which you wish to claim credit. After you have answered all the questions, click on the Exam Summary button. A Claim Credit button will appear on this page if you have achieved a passing score of 70% or better. If you did not achieve a passing score, please click the Reset Scores link and retake the exam.
  3. Click the Claim Credit button and answer the evaluation questions in the pop-up window.
  4. Enter the total amount of time you actually spent in the activity in the box provided. Please note that you may only claim once for each module in this activity. Click Submit.
  5. You will receive a message that your request has been submitted and a link to view your certificate. You may view and download the certificate when you receive the message, you may also view it at any time in the My Transcript section of My ACC.