Study of the evolution of masked bifascicular block

Masked bifascicular block (MBB) (absent or minimal S in I and VL, high R in Vi and AQRS approximately -60 degrees) is a rare condition. We have found 16 such cases in the last 12 years, thirteen male and three female, mean age 70 +/- 9 years. The conventional electrocardiogram was tabulated and the clinical features and evolution of the patients were followed over 39.1 +/- 32 months. Ten patients required pacemakers, nine because of complete atrioventricular (AV) block or increase in the previous AV block. Seven patients died (follow-up 27.3 +/- 32 months), five from heart failure. This study shows: (1) MBB is a subgroup of patients with a high risk of advanced atrioventricular block; (2) a pacemaker implant does not significantly reduce the high mortality in this group because of the severity of the underlying disease; (3) these results should be evaluated in a larger series of patients in order to confirm our provisional results.