What Is Complete Heart Block?
Complete heart block means that there's a complete separation of electrical activity between the upper and lower chambers of the heart. Without prompt medical attention, it can be fatal.
Your heart has a carefully coordinated electrical system that controls how it beats. When the heart's usual steady flow of electrical signals is interrupted, it can result in potentially dangerous conditions.
One of these is a complete heart block, also known as third-degree atrioventricular block.
Complete heart block occurs when electrical impulses that begin in the heart's upper chambers (atria) don't travel down to the lower chambers (ventricles). When this happens, the ventricles may not be able to contract properly and pump blood out to the lungs and the rest of the body.
Complete heart block is the most serious type of heart block. First-degree heart block is the mildest and is characterized by a slowdown of electrical impulses from the atria to the ventricles. Second-degree heart block means the impulses occasionally don't reach the ventricles at all, causing the heart to skip a beat.
Complete heart block is considered a medical emergency. Without prompt medical attention, it can be life threatening.
This article will take a closer look at complete heart block and its causes, symptoms, treatment, and outlook.
What causes complete heart block?
Complete heart block has a variety of possible causes. In many cases, it may be caused by some type of heart disease, such as:
a heart attack
cardiomyopathy (weakening of the heart muscle)
myocardial fibrosis (scarring of heart tissue)
heart valve disease
Certain medications may also cause complete heart block.
Anti-arrhythmic drugs — which doctors prescribe to treat heart rhythms that are too fast, too slow, or unpredictable — can sometimes trigger a heart block. Digoxin, a drug commonly used to treat heart failure, is also associated with heart block.
An imbalance of certain electrolytes, such as potassium, can trigger complete heart block.
In rare cases, a baby may be born with the condition. Congenital third-degree heart block affects about 1 in 20,000 to 25,000 live births.
What are the risk factors?
Your risk of developing complete heart block increase with age, especially if you have heart-related issues. An estimated 5% to 10% of people over age 70 who have a history of heart disease develop complete heart block.
A 2019 study suggests that people who do not manage their blood pressure or blood glucose levels may also face a greater risk of developing complete heart block.
What are the symptoms?
Some people with complete heart block experience no noticeable symptoms. For others, symptoms may develop gradually or come on suddenly.
Medical emergency
Call emergency medical services (9-1-1) in the U.S., if you experience the following symptoms of heart block, and are also associated with heart attack:
lightheadedness or dizziness
fatigue
fainting
shortness of breath
chest pain or pressure
How is complete heart block diagnosed?
To diagnose complete heart block, your doctor must be able to assess the electrical activity in the heart. This is usually done with an electrocardiogram (EKG or ECG).
An EKG is a noninvasive test that uses electrodes placed on the chest to record your heart's electrical activity. It can detect many types of arrhythmias, including complete heart block.
In some cases, an EKG may not diagnose the condition. This is because complete heart block can be intermittent, meaning it may come and go.
That's why diagnosis may also involve heart rhythm monitoring. This is done with a Holter monitor or a patch monitor. These devices continuously monitor and record your heart's rate and rhythm for 24 hours or longer.
In addition to these diagnostic tests, your doctor will also:
review your medical history
ask about your symptoms
perform a physical examination
review the medications you're currently taking
What is the treatment for complete heart block?
When complete heart block is first diagnosed, doctors may try to restore healthy electrical activity in the heart with the drug atropine. It's given in cases of bradycardia, an atypically slow heart rhythm. The drug can sometimes work in cases where complete heart block is triggered by a heart attack or medications.
If complete heart block was caused by a heart attack, a temporary pacemaker may also be used to help restore the heart's rate and rhythm until the heart muscle has recovered and has healthy blood flow.
In most cases of complete heart block, however, a permanent implantable pacemaker is the only solution. A pacemaker is a small, battery-powered device that sends electrical signals through thin, flexible leads into the heart to maintain a steady rhythm.
If doctors determine that complete heart block is due to a reversible cause, addressing the cause may cause the heart block to go away. For instance, if a medication triggered complete heart block, treatment will likely involve switching to a different medication.
How serious is complete heart block?
Complete heart block can lead to serious complications, including cardiac arrest, the abrupt halt to heart and lung function. Cardiac arrest can be fatal if not treated immediately.
Because complete heart block causes the heart to work harder to pump blood, one complication is heart failure, a chronic weakening of the heart's pumping ability.
Complete heart block also means a reduction in blood flow to the brain, which can cause fainting and falls.
What is the outlook?
The outlook for complete heart block is much more favorable when it's diagnosed and treated as soon as possible. If complete heart block is treated promptly with a pacemaker or other treatment protocols, the outlook for sustained heart health is promising.
Similarly, if complete heart block can be reversed by changing or eliminating certain medications or correcting an electrolyte imbalance, the outlook is excellent.
However, even with the right treatment, people with complete heart block are at greater risk of heart failure. If you've had complete heart block, it's especially important to work closely with your doctor or cardiologist to make lifestyle changes and to stay on track with any treatment plan.
Bottom line
Complete heart block is the most serious type of heart block. It means that there's a total block, or separation of electrical activity, between the upper chambers (atria) and lower chambers (ventricles) of the heart. It's considered a medical emergency and can be fatal if not treated right away.
Complete heart block is often caused by heart disease or a structural issue with the heart. It may also be caused by medications or an electrolyte imbalance. In rare cases, a baby may be born with this condition.
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While my mom was "furious," my dad recalled feeling irritated, but it was far down on the list of things he was thinking about. "At the moment, I was numb," he says. "I didn't dwell on it just because I wasn't part of that. I'm not much online." Both of these reactions felt true to me. There were much bigger things going on that day, but it also felt incredibly violating to read these inaccuracies hours after such a seismic event. "In the early days of grief, everything feels disorienting. You're trying to make sense of a world that no longer contains someone you love," says Soffer, the Modern Loss Handbook author. Cole Kan/CNET/Getty Images The body takes on a heavy load in the days after a loved one dies. Early stages of bereavement have been associated with increased heart rate, higher blood pressure and elevated cortisol levels. "Grief is not just about loss, it's about the erosion of control. And these AI obituaries just take another thing from mourners -- the ability to choose how and when and by whom their loved one's story is told," Soffer says. But others contend that AI tools have actually been a positive introduction to the mourning process. Allyse R. Worland, a funeral director in Indiana, says AI obituary spam has been a "rare occurrence", and she's mostly heard good things about the tools. "I've seen it as a positive," she tells me. "Families feel like that's one less thing on their plate. They feel empowered. Because a lot of the families that I meet, they are completely stressed out." That made sense to me. I was in charge of writing Jamie's obituary, and I do remember feeling stressed about the prospect. But I also remember sitting around with my family trying to find the perfect word for Jamie's laugh. (We ended up going with "hee-haw snort.") I couldn't help but think AI would have robbed us of that experience. "You have a very easy defamation case if it's false information about the family that's still alive. It becomes a little harder when you want to build a defamation claim based on a defamation of the deceased themselves." Nikolas Guggenberger, University of Houston law professor Becky Robison, a writer and death educator who's published a guide to writing obituaries, describes the process as cathartic. "For me, putting together my parents' obituaries was very emotionally meaningful," she says. "Let me celebrate both of my parents who I've lost too soon. Let me tell people why I love them. "It won't solve your grief, but I think it can be a really meaningful way to work through some of that grief." How to identify AI obituary spam, and what to do if you see it I would approach any obituary you see on social media or Google with extreme skepticism. Here are some common red flags to look out for before clicking a link: Consider the source : Most of the AI obits I saw were distributed by bot accounts that exclusively posted links to obituary sites. If that's the case, it's a near certainty that the obituary has no connection to the deceased. : Most of the AI obits I saw were distributed by bot accounts that exclusively posted links to obituary sites. If that's the case, it's a near certainty that the obituary has no connection to the deceased. Check the time : If you see the link to an obituary within 24 hours after someone passes, it probably didn't come from the family. Obituaries are generally published within a week of the death and rarely within the first day or two. : If you see the link to an obituary within 24 hours after someone passes, it probably didn't come from the family. Obituaries are generally published within a week of the death and rarely within the first day or two. Examine the URL: Unless it's posted on the website of a local funeral home, newspaper or I would be inclined to write off an obituary as AI-generated with no input from the loved ones of the deceased. Another giveaway is that the URL has "HTTP" and not "HTTPS" at the beginning, which indicates that the data sent between your computer and the website is not encrypted. Unless it's posted on the website of a local funeral home, newspaper or I would be inclined to write off an obituary as AI-generated with no input from the loved ones of the deceased. Another giveaway is that the URL has "HTTP" and not "HTTPS" at the beginning, which indicates that the data sent between your computer and the website is not encrypted. Look for specifics: AI obits are usually quite vague and rely on generalizations like "cherished member of the community" or "kind heart." If you do identify a fake obituary about someone you know, these are some steps you can take to have them taken down: Representatives for the Federal Trade Commission and Federal Communications Commission declined my request for a comment for this article. Human instincts Rereading that first AI obituary we were sent, I'm oddly touched by this machine portrait. I love the photo it chose for the header: Jamie proudly holding up a $20 bill with a Corona nearby. She looks beautiful. I have no idea what the context is. I still feel some far-off echoes of anger when I see the headline about Jamie's supposed autism cause of death, but it feels a little like getting mad at my refrigerator. It's likely that in the near future, AI obituaries will improve so much that I wouldn't be able to tell the real from the fake. I'm not sure if that will feel better or worse. "She was more than just a conglomeration of data. She was a real person," my mom says, reflecting on her initial outrage. After spending so much time reading Facebook posts from the newly grieving, I couldn't help but feel that there was something irreplaceably human about that instinct to reach out for connection in the most disorienting moments. Maybe the instinct to monetize it is too. Visual Designer | Cole Kan Art Director | Jeff Hazelwood Creative Director | Viva Tung Video Presenter | Owen Poole Video Editor | JD Christison Project Manager | Danielle Ramirez Editors | Katie Collins, Corinne Reichert Director of Content | Jonathan Skillings
Medscape
2 hours ago
- Medscape
Metformin Timing and Pregnancy Outcomes in PCOS
For women with polycystic ovary syndrome (PCOS), continuing preconception metformin throughout the first trimester rather than stopping it at the positive pregnancy test might reduce the risk for miscarriage and improve pregnancy outcomes. METHODOLOGY: Researchers conducted a meta-analysis by searching the literature across MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases to determine how the timing of metformin treatment specifically affects pregnancy outcomes in women with PCOS. They included 12 randomised controlled trials including 1708 women with PCOS and compared preconception metformin, continued until at least pregnancy confirmation, with placebo or no treatment. The primary outcome was the miscarriage rate; secondary outcomes were the clinical pregnancy rate and live birth rate. Indirect comparisons between continuing metformin throughout the first trimester and stopping it at pregnancy confirmation were performed using the Bucher technique to evaluate key pregnancy outcomes. TAKEAWAY: Women who continued preconception metformin throughout the first trimester had a lower risk for miscarriage (odds ratio [OR], 0.64; 95% CI, 0.32-1.25) and higher clinical pregnancy rates (OR, 1.57; 95% CI, 1.11-2.23) and live birth rates (OR, 1.24; 95% CI, 0.59-2.61) than those who received either placebo or no treatment. Women who stopped metformin at pregnancy confirmation showed a higher risk for miscarriage (OR, 1.46; 95% CI, 0.73-2.90) and higher clinical pregnancy rates (OR, 1.35; 95% CI, 1.01-1.80) than those who received either placebo or no treatment. Women who continued metformin throughout the first trimester experienced a lower risk for miscarriage (OR, 0.44; 95% CI, 0.17-1.16) and higher clinical pregnancy rates (OR, 1.16; 95% CI, 0.74-1.83) and live birth rates (OR, 1.14; 95% CI, 0.41-3.13) than those who stopped metformin at the positive pregnancy test. IN PRACTICE: "The [study] findings suggest that discontinuing metformin upon pregnancy confirmation may cause a delayed 'rebound' effect, potentially increasing insulin resistance and adversely affecting pregnancy outcomes later in the first trimester," the authors wrote. SOURCE: This study was led by James Cheshire, PhD, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, England. It was published online on June 03, 2025, in the American Journal of Obstetrics and Gynecology . LIMITATIONS: The major limitation of this study was the heterogeneous nature of the population and the overall low quality of evidence. Findings may not be applicable to all PCOS phenotypes as the study did not account for differences in phenotypes and degrees of hyperandrogenism and insulin resistance in women with PCOS. Many studies did not stratify pregnancy outcome data on the basis of BMI, preventing meaningful subgroup analyses and potentially affecting the findings. DISCLOSURES: This study did not receive any external funding. The authors declared having no competing interests.
