In hemodialysis patients, arrhythmias are a significant concern due to mineral bone disease, despite efforts to address abnormalities in plasma calcium and phosphorus levels. Metastatic calcification, the abnormal accumulation of calcium in soft tissues, is a common consequence of these metabolic disorders and can contribute to the development of cardiac conduction issues. This case report is significant as it emphasizes the serious cardiovascular risks associated with metastatic calcification in hemodialysis patients, particularly its role in developing arrhythmias such as third-degree atrioventricular block. Our case study focused on the unique clinical presentation of a 43-year-old female patient with end-stage renal disease (ESRD) who was receiving hemodialysis and had third-degree atrioventricular block. After a 10-day period of temporary transvenous pacing, she successfully reverted to sinus rhythm. This demonstrates the critical importance of early and effective interventions in managing cardiac complications associated with mineral bone disease in ESRD patients, indicating that timely treatment can result in positive outcomes even in severe cases.