Idioventricular rhythm can exist in the presence or absence of a complete AV block. It is a slow rhythm with a rate of around 20 – 40 per minute. It is seen as a wide QRS rhythm, without a preceding P wave or P waves with totally varying PR interval due to AV dissociation. Idioventricular focus is not a stable pacemaker and hence it is prone for slowing down into asystole producing Stokes-Adam attacks. If it is due to a reversible condition, temporary pacing, either trans venous or transcutaneous, is needed to stabilise the hemodynamic status. Permanent pacing is needed if the condition is not reversible.