An Overview of Complete Heart Block Treatment for ACLS 2020

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What is a Complete Heart Block?

A complete, or third-degree heart block is a type of bradyarrhythmia. Bradyarrhythmias are variations of a bradycardia, where the regular rhythm is altered. The bradyarrhythmias include second-degree AV block type I, second-degree AV block type II, and complete (third-degree) AV block.

RELATED: A Guide to Bradycardia Pediatric Care

Third degree heart block is when there’s no electrical communication between the atria and the ventricles. As a result, the ventricles usually start to beat on their own, thereby creating an inefficient heart rate that affects the heart’s ability to pump blood efficiently throughout the body. Third-degree AV block is a serious issue that can cause cardiac arrest and require a pacemaker.

RELATED: Understanding Advanced Algorithms for the Treatment of Ventricular Fibrillation

The Rules for Third-Degree AV Block (Complete Heart Block)

Third-Degree AV Block (Complete Heart Block) EKG
Third-Degree AV Block (Complete Heart Block)


The R-R interval and the P-P interval are regular.


The normal person’s heart rate is usually between 60–100 Bpm. The ventricular focus (between chambers) will result in a faster, 20–40 BPM. The junctional focus is around 40–60 BP and the outlet (escape) rhythm typically results in an inadequate, 30-45 BPM.

P Wave

The P waves are upright and uniform. There is an absence of a P wave before some QRS complexes. The impulses at the atria aren’t making it to the ventricles.

PR Interval

PR interval is determined from conducted beats and is usually consistent or prolonged.

QRS Complex

The QRS complex interval may be normal but could also be prolonged.

RELATED: The Latest ACLS Guidelines and How to Implement Them in Your Practice

Types of Treatment for a Complete Heart Block

Symptoms of unstable heart blocks may include dizziness, difficulty breathing, chest pain, fainting, and fluctuating mental state. When encountering a patient with a complete heart block, follow this algorithm to identify and treat the underlying cause as well as determine further expert consultation needs.

Adult Bradycardia Algorithm for Identifying and Treating Complete Heart Blocks

Adult bradycardia algorithm

Where Can I Learn More About Complete Heart Block Treatment in Advanced Cardiovascular Life Support (ACLS)?

Download a FREE ACLS algorithms course pack from Medical ProCerts that includes lessons and algorithms to help you study and become competent in identifying and treating abnormal heart conditions like Complete Heart Block.

Sign up and certify today at!

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