Algorithm showing the treatment approach to the patient with complete heart block

ECG: electrocardiogram; CHB: complete heart block; BP: blood pressure; HF: heart failure; IV: intravenous; PPM: permanent pacemaker.

* The initial dose of atropine is 1 mg IV. This dose may be repeated every 3 to 5 minutes to a total dose of 3 mg.

¶ While transcutaneous pacing may be initially successful in stabilizing the patient, it may not be consistently reliable. Central venous access should be considered in the event that urgent transvenous pacing is required.

Δ Dopamine IV infusion typically begins at a dose of 5 mcg/kg/minute and is titrated as needed to achieve an optimal clinical and hemodynamic response (maximum dose of 20 mcg/kg/minute).

◊ Dobutamine IV infusion typically begins at a dose of 2 to 5 mcg/kg/minute and is titrated as needed to achieve an optimal clinical and hemodynamic response. The usual maintenance dose of dobutamine is 2 to 10 mcg/kg/minute (maximum dose of 20 mcg/kg/minute).