Key result
Masquerading bundle branch block is linked to ~13 ms longer HV intervals than standard bifascicular block.
Why the study?
Does masquerading bundle branch block indicate worse conduction system impairment and a higher need for pacemaker implantation compared to standard bifascicular block?
Cross-Sectional (n=45)
Single-blind
Does masquerading bundle branch block indicate worse conduction system impairment and a higher need for pacemaker implantation compared to standard bifascicular block?
Masquerading bundle branch block is a marker of severe myocardial and conduction system impairment, strongly predicting the need for pacemaker implantation compared to standard bifascicular block.
Answers are grounded in this paper and cite their sources.
Masquerading bundle branch block may indicate more advanced conduction disease; leaves open whether routine EPS or earlier pacing is warranted pending prospective data.
BACKGROUND: Maskerading bundle branch block (MBBB) is a rare variant of standard bifascicular bundle branch block (SBBB), associated with poor prognosis and a higher need for pacemaker implantation. Most available data are limited to case reports and reviews. METHODS: In this prospective cross-sectional study, we evaluated 27 patients with MBBB (Group I) and 18 with SBBB (Group II), all undergoing echocardiography, 24-h Holter monitoring, and invasive electrophysiological study (EPS) after recruitment. RESULTS: Group I patients had worse functional status (NYHA III-IV), larger ventricular diameters, and lower ejection fraction. The HV interval was significantly longer in Group I (66.3 ± 18.3 vs. 52.9 ± 8.1 ms; p = 0.006). Pacemaker implantation was required in 48% of Group I patients versus none in Group II (p = 0.001). Persistent atrial fibrillation was also more frequent in Group I (39.5% vs. 16.6%; p = 0.018). CONCLUSION: MBBB is associated with more severe myocardial and conduction system impairment compared to SBBB, supporting its role as a marker of worse prognosis.
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Albuquerque et al. (2026) conducted a cross-sectional in Bifascicular block (Masquerading vs Standard) (n=45). Masquerading bundle branch block (MBBB) vs. Standard bifascicular bundle branch block (SBBB) was evaluated on HV interval on electrophysiological study (p=0.006). Masquerading bundle branch block was associated with a significantly longer HV interval compared to standard bifascicular block (66.3 vs 52.9 ms, p=0.006) and a higher rate of pacemaker implantation.
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