Lown-Ganong-Levine syndrome: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(37 intermediate revisions by one other user not shown)
Line 4: Line 4:
{{CMG}} {{AE}} {{Usman Ali Akbar}}
{{CMG}} {{AE}} {{Usman Ali Akbar}}


{{SK}} Lown-Ganong-Levine Syndrome, LGL syndrome, Pre-excitation syndromes, Short PR Normal QRS Complex Syndrome, Clerc-Lévy-Cristesco syndrome, Coronary nodal rhythm syndrome, Short PQ interval syndrome, Short P-R syndrome.
{{SK}} Lown-Ganong-Levine [[Syndrome]], LGL syndrome, [[Pre-excitation syndrome|Pre-excitation syndromes]], [[Short PR interval|Short PR]] [[Normal]] [[QRS complex|QRS Complex]] [[Syndrome]], Clerc-Lévy-Cristesco syndrome, [[Coronary]] [[Node (physics)|nodal]] [[rhythm]] [[syndrome]], Short PQ [[Interval (mathematics)|interval]] [[syndrome]], Short [[P-R interval|P-R]] [[syndrome]].


==Overview==
==Overview==
Lown-Ganong-Levine syndrome (LGL) is actually a [[pre-excitation syndrome|pre-excitation syndrome]] with [[EKG]] findings including short PR interval, narrow or normal [[QRS complex]], and a normal [[P wave]]. It is caused by the presence of [[accessory]] bundles of fibers known as James fibers which lead to the development of abnormal conduction pathways. The LGL syndrome was named after Bernard Lown, William Francis Ganong, and Samual Levine who described it in 1952. Patients of LGL usually present with a history of [[Palpitation|palpitations]], [[lightheadedness]], [[shortness of breath]], and sometimes chest pain. There is an increased risk of [[tachyarrhythmias]] and [[syncope]]. [[EKG]] is the principal modality of investigation for establishing a [[diagnosis]]. Usually, antiarrhythmics are given to prevent the development of tachyarrhythmias but recently [[radiofrequency ablation]] of the accessory pathway has been the mainstay of treatment with a good prognosis.
Lown-Ganong-Levine [[syndrome]] (LGL) is actually a [[pre-excitation syndrome|pre-excitation syndrome]] with [[EKG]] findings including short [[PR interval]], narrow or [[normal]] [[QRS complex]], and a [[normal]] [[P wave]]. It is [[Causes|caused]] by the [[Presenting symptom|presence]] of [[accessory]] [[Bundle branch|bundles]] of [[Fiber|fibers]] known as [[James fibers]] which lead to the [[development]] of [[abnormal]] [[Conduction System|conduction pathways]]. The LGL [[syndrome]] was named after Bernard Lown, William Francis Ganong, and Samual Levine who described it in 1952. [[Patients]] of LGL usually [[Presenting symptom|present]] with a [[History and Physical examination|history]] of [[Palpitation|palpitations]], [[lightheadedness]], [[shortness of breath]], and sometimes [[chest pain]]. There is an increased [[RiskMetrics|risk]] of [[tachyarrhythmias]] and [[syncope]]. [[EKG]] is the principal [[modality]] of [[Investigational product|investigation]] for establishing a [[diagnosis]]. Usually, [[antiarrhythmics]] are given to [[Prevention|prevent]] the [[Development (biology)|development]] of [[tachyarrhythmias]] but recently [[radiofrequency ablation]] of the [[accessory pathways]] has been the mainstay of [[treatment]] with a good [[prognosis]].


==Historical Perspective==
==Historical Perspective==


*Following is timeline of of LGL syndrome with its discovery and developments of its bypass tracts.<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref><ref name="Manning 1978 pp. 576–577">{{cite journal | last=Manning | first=G W | title=Lown-Ganong-Levine syndrome. | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=58 | issue=3 | year=1978 | issn=0009-7322 | pmid=679452 | doi=10.1161/01.cir.58.3.576 | pages=576–577}}</ref><ref name="DOUGLAS 1972 pp. 1143–1144">{{cite journal | last=DOUGLAS | first=JOHN E. | title=Lown-Ganong-Levine Syndrome | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=45 | issue=5 | year=1972 | issn=0009-7322 | pmid=5020803 | doi=10.1161/01.cir.45.5.1143 | pages=1143–1144}}</ref>
*Following is the timeline of LGL [[syndrome]] with its discovery and [[Development|developments]] of its [[Bypass tract|bypass tracts]]:<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref><ref name="Manning 1978 pp. 576–577">{{cite journal | last=Manning | first=G W | title=Lown-Ganong-Levine syndrome. | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=58 | issue=3 | year=1978 | issn=0009-7322 | pmid=679452 | doi=10.1161/01.cir.58.3.576 | pages=576–577}}</ref><ref name="DOUGLAS 1972 pp. 1143–1144">{{cite journal | last=DOUGLAS | first=JOHN E. | title=Lown-Ganong-Levine Syndrome | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=45 | issue=5 | year=1972 | issn=0009-7322 | pmid=5020803 | doi=10.1161/01.cir.45.5.1143 | pages=1143–1144}}</ref>


{| class="wikitable"
{| class="wikitable"
Line 20: Line 20:
| align="center" style="background:#DCDCDC;" + |'''1938'''
| align="center" style="background:#DCDCDC;" + |'''1938'''
|
|
*Clerc, Levy, and Critesco in 1938 first reported cases in which there was occurrence of frequent paroxysms of [[tachycardia]]. The [[EKG]] of such patients consist of a short PR interval and a normal QRS interval.
*Clerc, Levy, and Critesco in 1938 first [[Reporting results|reported]] [[Case Report Form|cases]] in which there was an occurrence of frequent [[Paroxysm|paroxysms]] of [[tachycardia]].
*The [[EKG]] of such [[patients]] consisted of a [[short PR interval]] and a [[normal]] [[QRS Interval|QRS interval]].
|-
|-
| align="center" style="background:#DCDCDC;" + |'''1946'''
| align="center" style="background:#DCDCDC;" + |'''1946'''
|
|
*Burch and Kimball hinted on existence of the [[atrio-Hisian pathway]]
*Burch and Kimball hinted about the existence of the [[Atrio-Hisian fibers|Atrio-Hisian pathway.]]
|-
|-
| align="center" style="background:#DCDCDC;" + |'''1952'''
| align="center" style="background:#DCDCDC;" + |'''1952'''
|
|
*The Lown-Ganong-Levine (LGL) pattern was described in 1952 by Bernard Lown, William Francis Ganong, and Samual Levine.
*The Lown-Ganong-Levine (LGL) [[pattern]] was described in 1952 by Bernard Lown, William Francis Ganong, and Samual Levine.
|-
|-
| align="center" style="background:#DCDCDC;" + |'''1961-1974'''
| align="center" style="background:#DCDCDC;" + |'''1961-1974'''
|
|
*In 1961 and subsequently in 1974 anatomic pathway was identified and reported by James and Brechemacher respectively.
*In 1961 and subsequently, in 1974, an [[anatomic]] pathway was identified and reported by James and Brechemacher respectively.
|}
|}
[[File:Timeline-LGL.jpg|600px|thumb|none|Historic Timeline of LGL Syndrome]]
[[File:Timeline-LGL.jpg|600px|thumb|none|Historic Timeline of LGL Syndrome]]
Line 38: Line 39:
==Classification==
==Classification==


*LGL syndrome can be classified based on the accessory pathways into the following categories:<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref><ref name="Manning 1978 pp. 576–577">{{cite journal | last=Manning | first=G W | title=Lown-Ganong-Levine syndrome. | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=58 | issue=3 | year=1978 | issn=0009-7322 | pmid=679452 | doi=10.1161/01.cir.58.3.576 | pages=576–577}}</ref>
*LGL [[syndrome]] can be [[Classification|classified]] based on the [[accessory pathways]] into the following categories:<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref><ref name="Manning 1978 pp. 576–577">{{cite journal | last=Manning | first=G W | title=Lown-Ganong-Levine syndrome. | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=58 | issue=3 | year=1978 | issn=0009-7322 | pmid=679452 | doi=10.1161/01.cir.58.3.576 | pages=576–577}}</ref>


{| class="wikitable"
{| class="wikitable"
Line 45: Line 46:
! style="background:#4479BA;width:200px; color: #FFFFFF;" + |Description
! style="background:#4479BA;width:200px; color: #FFFFFF;" + |Description
|-
|-
| align="center" style="background:#DCDCDC;" + |'''James Fibers'''
| align="center" style="background:#DCDCDC;" + |'''[[James fibers]]'''
|
|
*They can be present as a normal part of [[AV node]] but these fibers have been established as an anatomic reason for LGL syndrome
*They can be [[Presenting symptoms|present]] as a [[normal]] part of the [[AV node]] but these [[Fiber|fibers]] have been established as an [[anatomic]] [[Reasoning|reason]] for LGL [[syndrome]].
|-
|-
| align="center" style="background:#DCDCDC;" + |'''Brechmacher fibers'''
| align="center" style="background:#DCDCDC;" + |'''[[Brechenmacher fibers]]'''
|
|
*These atrio-Hisian tracts have a frequency of 0.03% and contribute theoretically towards LGL syndrome.
*These [[Atrio-Hisian fibers|atrio-Hisian tracts]] have a [[frequency]] of 0.03% and contribute theoretically towards LGL [[syndrome]].
|-
|-
| align="center" style="background:#DCDCDC;" + |'''Intra-nodal bypass tracts'''
| align="center" style="background:#DCDCDC;" + |'''Intra-[[Node (physics)|nodal]] [[Bypass tract|bypass tracts]]'''
|
|
*Intra-nodal bypass tracts allow the conduction of rapid [[action potential]] through [[Atrioventricular node|AV node]] bypassing other pathways with slow conduction.
*The intra-[[Node (physics)|nodal]] [[Bypass tract|bypass tracts]] allow the [[Conduction System|conduction]] of rapid [[action potential]] through [[Atrioventricular node|AV node]] [[Bypass|bypassing]] other pathways with [[slow]] [[Conduction System|conduction]].
|}
|}


==Pathophysiology==
==Pathophysiology==


*The [[pathophysiology]] of LGL syndrome is not yet understood completely.
*The [[pathophysiology]] of LGL [[syndrome]] is not yet understood completely.
*Multiple theories have been proposed to suggest the mechanism of LGL. <ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>
*Multiple [[Theory|theories]] have been proposed to [[Suggestion|suggest]] the [[Mechanism (biology)|mechanism]] of LGL.<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>
*The current theory supporting the mechanism of LGL is that it may result from numerous underlying causes that involve [[junctional pathways]] that partially or wholly bypass the [[Atrioventricular node|AV node]] with subsequent normal conduction down the bundle of His.<ref name="Benditt Pritchett Smith Wallace 1978 pp. 454–465">{{cite journal | last=Benditt | first=D G | last2=Pritchett | first2=L C | last3=Smith | first3=W M | last4=Wallace | first4=A G | last5=Gallagher | first5=J J | title=Characteristics of atrioventricular conduction and the spectrum of arrhythmias in lown-ganong-levine syndrome. | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=57 | issue=3 | year=1978 | issn=0009-7322 | pmid=624155 | doi=10.1161/01.cir.57.3.454 | pages=454–465}}</ref>
*The [[current]] [[theory]] supporting the [[Mechanism (biology)|mechanism]] of LGL is that it may [[result]] from numerous underlying [[causes]] that involve [[junctional pathways]] which partially or wholly [[bypass]] the [[Atrioventricular node|AV node]] with subsequent [[normal]] [[Conduction System|conduction]] down the [[bundle of His]].<ref name="Benditt Pritchett Smith Wallace 1978 pp. 454–465">{{cite journal | last=Benditt | first=D G | last2=Pritchett | first2=L C | last3=Smith | first3=W M | last4=Wallace | first4=A G | last5=Gallagher | first5=J J | title=Characteristics of atrioventricular conduction and the spectrum of arrhythmias in lown-ganong-levine syndrome. | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=57 | issue=3 | year=1978 | issn=0009-7322 | pmid=624155 | doi=10.1161/01.cir.57.3.454 | pages=454–465}}</ref>
*The three [[accessory pathways]] as discussed in [[classification]] has been proposed to be the main triggering factors for the development of LGL.<ref name="Denes Wu Rosen 1974 pp. 343–346">{{cite journal | last=Denes | first=Pablo | last2=Wu | first2=Delon | last3=Rosen | first3=Kenneth M. | title=Demonstration of Dual A-V Pathways in a Patient with Lown-Ganong-Levine Syndrome | journal=Chest | publisher=Elsevier BV | volume=65 | issue=3 | year=1974 | issn=0012-3692 | doi=10.1378/chest.65.3.343 | pages=343–346}}</ref>
*The three [[accessory pathways]] as discussed in the [[classification]] section have been [[Proposition|proposed]] to be the main [[Trigger|triggering]] factors for the [[development]] of LGL.<ref name="Denes Wu Rosen 1974 pp. 343–346">{{cite journal | last=Denes | first=Pablo | last2=Wu | first2=Delon | last3=Rosen | first3=Kenneth M. | title=Demonstration of Dual A-V Pathways in a Patient with Lown-Ganong-Levine Syndrome | journal=Chest | publisher=Elsevier BV | volume=65 | issue=3 | year=1974 | issn=0012-3692 | doi=10.1378/chest.65.3.343 | pages=343–346}}</ref>
*Lown-Ganong-Levine pattern may occur including the following fibers:
*Lown-Ganong-Levine [[pattern]] may occur including the following [[Fiber|fibers]]:
**Brechenmacher fibers (account for 0.03% of the patients presenting with LGL)
**[[Brechenmacher fibers]] (account for 0.03% of the [[patients]] [[Presenting symptom|presenting]] with LGL)
**Intranodal bypass tracts
**Intra-[[Node (physics)|nodal]] [[Bypass tract|bypass tracts]]
**James fibers
**[[James fibers]]
*The intra-nodal bypass tracts allow the conduction of rapid action potential through AV-node bypassing the other slow pathways.
*The intra-[[Node (physics)|nodal]] [[Bypass tract|bypass tracts]] allow the rapid [[Conduction System|conduction]] of [[action potential]] through the [[AV node]] [[Bypass|bypassing]] the other [[slow]] pathways.


[[File:LGL-bypass.jpg|thumb|500px|none|LGL Syndrome associated bypass tracts ]]
[[File:LGL-bypass.jpg|thumb|500px|none|LGL Syndrome associated bypass tracts ]]
Line 74: Line 75:
==Causes==
==Causes==


*The causes of LGL syndrome have not been completely understood yet.
*The exact [[causes]] of LGL [[syndrome]] have not been completely understood yet.
*However, the presence of following accessory pathways can predispose a patient to the development of LGL syndrome:
*However, the [[Presenting symptom|presence]] of following [[accessory pathways]] can predispose a [[patient]] to the [[development]] of LGL [[syndrome]]:<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>
**James Fibers
**[[James fibers]]
**Brechmacher fibers
**[[Brechenmacher fibers]]
**Intra-nodal fibers
**Intra-[[Node (physics)|nodal]] [[Fiber|fibers]]
*Sometimes, patients with LGL syndrome have a history of congenital heart disease.
*Sometimes, [[patients]] with LGL [[syndrome]] have a [[History and Physical examination|history]] of [[congenital heart disease]].


==Differentiating Lown-Ganong-Levine Syndrome from other Diseases==
==Differentiating Lown-Ganong-Levine Syndrome from other Diseases==


*The differential diagnosis for Lown-Ganong-Levine includes following diseases:
*The [[Differential Diagnosis Table|differential diagnosis]] for Lown-Ganong-Levine [[syndrome]] includes the following [[diseases]] as shown in the [[Differential Diagnosis Table|table]] below:




Line 98: Line 99:
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Co-existing Conditions
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Co-existing Conditions
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |'''LGL Syndrome'''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |'''LGL [[Syndrome]]'''
|
|
*[[Irregularly irregular pulse|Irregularly irregular]]
*[[Irregularly irregular pulse|Irregularly irregular]]
Line 107: Line 108:


|
|
*Short PR interval
*[[Short PR interval]]
|
|
*Normal / Narrow QRS complex, [[Consistency (statistics)|consistent]], and [[normal]] in [[Morphology (biology)|morphology]]
*[[Normal]]/Narrow [[QRS complex]], [[Consistency (statistics)|consistent]], and [[normal]] in [[Morphology (biology)|morphology]]
|
|
*Does break with [[adenosine]] or [[vagal maneuvers]]
*Does break with [[adenosine]] or [[vagal maneuvers]]
|
|
*In a retrospective study conducted by Bernard Lown, William Francis Ganong, and Samual Levine 200 electrocardiograms (EKG) of 13500 patients showed EKG findings with the prevalence of just over 1%.
*In a [[retrospective study]] conducted by Bernard Lown, William Francis Ganong, and Samual Levine, 200 [[electrocardiograms]] ([[EKG]]) of 13500 [[patients]] showed [[EKG]] findings with a [[prevalence]] of just over 1%.
*
*
|
|
Line 152: Line 153:
*Regular or [[Irregular heart rhythms|Irregular]]
*Regular or [[Irregular heart rhythms|Irregular]]
|
|
*75 (4:1 [[Blocking (statistics)|block]]), 100 (3:1 [[Blocking (statistics)|block]]) and 150 (2:1 [[Blocking (statistics)|block]]) [[beats per minute]] (bpm), but 150 is more common
*75 (4:1 [[Blocking (statistics)|block]]), 100 (3:1 [[Blocking (statistics)|block]]) and 150 (2:1 [[Blocking (statistics)|block]]) [[beats per minute]] ([[Beats per minute|bpm]]), but 150 is more common
|
|
*Sawtooth [[pattern]] of [[P waves]] at 250 to 350 [[Beats per minute|bpm]]
*Sawtooth [[pattern]] of [[P waves]] at 250 to 350 [[Beats per minute|bpm]]
Line 200: Line 201:
*[[Irregular heart rhythms|Irregular]]
*[[Irregular heart rhythms|Irregular]]
|
|
*[[Atrial]] rate is > 100 [[beats per minute]]
*[[Atrial]] [[rate]] is > 100 [[beats per minute]]
|
|
*Varying [[morphology]] from at least three [[Differentiate|different]] [[Focusing|foci]]
*Varying [[morphology]] from at least three [[Differentiate|different]] [[Focusing|foci]]
Line 255: Line 256:
|
|
*Breaks with [[vagal maneuvers]], [[adenosine]], [[diving reflex]], [[oculocardiac reflex]]
*Breaks with [[vagal maneuvers]], [[adenosine]], [[diving reflex]], [[oculocardiac reflex]]
|
|_
|
|
*[[Infant|Infants]]
*[[Infant|Infants]]
Line 353: Line 354:
==Epidemiology and Demographics==
==Epidemiology and Demographics==


*In a [[Retrospective cohort study|retrospective study]] conducted by Bernard Lown, William Francis Ganong, and Samual Levine  200 electrocardiograms (EKG) of 13500 patients showed EKG findings with the prevalence of just over 1%.<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>
*In a [[Retrospective cohort study|retrospective study]] conducted by Bernard Lown, William Francis Ganong, and Samual Levine, 200 [[electrocardiograms]] ([[EKG|EKGs]]) of 13500 [[patients]] showed [[EKG]] findings with the [[prevalence]] of just over 1%.<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>
   
   
===Age===
===Age===


*There is currently insufficient data regarding age predilection of LGL syndrome.
*There is currently insufficient data regarding [[age]] predilection of LGL [[syndrome]].
   
   
===Gender===
===Gender===


*There is currently insufficient data regarding gender predilection of LGL syndrome as LGL pattern is not associated with an increased incidence in one particular sex.
*There is currently insufficient data regarding gender predilection of LGL [[syndrome]] as the LGL [[pattern]] is not [[Association (statistics)|associated]] with an increased [[incidence]] in one particular [[Sex (activity)|sex]].
*However, Lown in 1952 reported 70.9% of the 34 cases in women.<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>
*However, Lown in 1952 reported 70.9% of the 34 cases in [[women]].<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>
   
   
===Race===
===Race===


*There is currently insufficient data regarding race predilection of LGL syndrome as LGL pattern is not associated with an increased incidence in one particular ethnic background.
*There is currently insufficient [[data]] regarding [[race]] predilection of LGL [[syndrome]] as the LGL [[pattern]] is not [[Association (statistics)|associated]] with an increased [[incidence]] in one particular [[Ethnic group|ethnic background]].


==Risk Factors==
==Risk Factors==


*The data regarding the risk factors predisposing to LGL syndrome is insufficient. However, the following conditions or factors may lead to the various pre-excitation syndromes:
*The [[data]] regarding the [[risk factors]] predisposing to LGL [[syndrome]] is insufficient. However, the following [[conditions]] or factors may lead to the various [[Pre-excitation syndrome|pre-excitation syndromes]]:<ref name="pmid14926053">{{cite journal| author=LOWN B, GANONG WF, LEVINE SA| title=The syndrome of short P-R interval, normal QRS complex and paroxysmal rapid heart action. | journal=Circulation | year= 1952 | volume= 5 | issue= 5 | pages= 693-706 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14926053  }} </ref>
**Presence of accessory bypass tracts
**Presence of [[Accessory pathway|accessory]] [[Bypass tract|bypass tracts]]
**The high-risk population for [[sudden cardiac death]] in patients with pre-excitation syndromes include the following:
**The high-risk [[population]] for [[sudden cardiac death]] in [[patients]] with [[Pre-excitation syndrome|pre-excitation syndromes]] includes the following:
***Policemen
***Policemen
***Athletes
***[[Athletes]]
***Firemen
***Firemen
***Pilots
***Pilots
Line 382: Line 383:
===Natural History===
===Natural History===


*LGL syndrome can be asymptomatic or can present with the following symptoms:
*LGL [[syndrome]] can be [[asymptomatic]] or can [[Presenting symptom|present]] with the following [[symptoms]]:
**[[Palpitation|Palpitations]]
**[[Palpitation|Palpitations]]
**[[Lightheadedness]]
**[[Lightheadedness]]
**[[Shortness of breath]]
**[[Shortness of breath]]
**[[Syncope]]
**[[Syncope]]
*In the case of congenital heart disease or genetic anomaly, it can also present as paroxysms of tachycardia or chest pain.<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>
*In the case of [[congenital heart disease]] or [[Genetic anomalies|genetic anomaly]], it can also [[Presenting symptom|present]] as [[Paroxysm|paroxysms]] of [[tachycardia]] or [[chest pain]].<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>


===Complications===
===Complications===


*There is an increased risk of developing [[Tachyarrhythmias|tachyarrhythmias.]]
*There is an increased risk of developing [[Tachyarrhythmias|tachyarrhythmias.]]
*Certain medications such as [[sympathomimetics]] should be used with caution in patients of LGL syndrome.
*Certain [[medications]] such as [[sympathomimetics]] should be used with caution in [[patients]] of LGL [[syndrome]].
*[[Digitalis]] does not produce any effect on LGL syndrome but it can slow down the conduction in the AV node which prevents [[AV reentrant tachycardia|AVRT]] in these patients.
*[[Digitalis]] does not produce any [[Effect size|effect]] on LGL [[syndrome]] but it can [[slow]] down the [[Conduction System|conduction]] in the [[AV node]] which [[Prevention (medical)|prevents]] [[AV reentrant tachycardia|AVRT]] in these [[patients]].
*Although [[beta-blockers]] do not directly affect the accessory pathway, however, they can slow conduction through the AV node similar to [[Digoxin|digitalis]].
*Although [[beta-blockers]] do not directly [[affect]] the [[accessory pathway]], however, they can [[slow]] [[Conduction System|conduction]] through the [[AV node]] similar to [[Digoxin|digitalis]].


===Prognosis===
===Prognosis===


*The overall prognosis of patients with LGL syndrome is good.
*The overall [[prognosis]] of [[patients]] with LGL [[syndrome]] is good.
*Patients are usually asymptomatic but some can develop certain clinical features such as:
*[[Patients]] are usually [[asymptomatic]] but some can [[Development|develop]] certain [[clinical]] [[Features (pattern recognition)|features]] such as:
**[[Palpitations]]
**[[Palpitations]]
**[[Shortness of breath]]
**[[Shortness of breath]]
Line 406: Line 407:
***[[Atrial flutter]]
***[[Atrial flutter]]
***[[AV reentrant tachycardia|AVRT]]
***[[AV reentrant tachycardia|AVRT]]
***Other tachyarrhythmias
***Other [[tachyarrhythmias]]
***They can also lead to the development of ventricular arrhythmias in rare cases.<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref><ref name="Benditt Pritchett Smith Wallace 1978 pp. 454–465">{{cite journal | last=Benditt | first=D G | last2=Pritchett | first2=L C | last3=Smith | first3=W M | last4=Wallace | first4=A G | last5=Gallagher | first5=J J | title=Characteristics of atrioventricular conduction and the spectrum of arrhythmias in lown-ganong-levine syndrome. | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=57 | issue=3 | year=1978 | issn=0009-7322 | pmid=624155 | doi=10.1161/01.cir.57.3.454 | pages=454–465}}</ref>
***They can also lead to the [[development]] of [[ventricular arrhythmias]] in [[rare]] cases.<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref><ref name="Benditt Pritchett Smith Wallace 1978 pp. 454–465">{{cite journal | last=Benditt | first=D G | last2=Pritchett | first2=L C | last3=Smith | first3=W M | last4=Wallace | first4=A G | last5=Gallagher | first5=J J | title=Characteristics of atrioventricular conduction and the spectrum of arrhythmias in lown-ganong-levine syndrome. | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=57 | issue=3 | year=1978 | issn=0009-7322 | pmid=624155 | doi=10.1161/01.cir.57.3.454 | pages=454–465}}</ref>


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
===Diagnostic Criteria===


*Characteristic ECG findings of LGL syndrome are <ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>
*Characteristic [[ECG]] findings of LGL [[syndrome]] are <ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>
**Short [[PR interval]] (<120ms)
**[[Short PR interval]] (<120ms)
**Normal [[P wave]] axis
**[[Normal]] [[P wave]] [[axis]]
**Normal/narrow [[QRS complex|QRS morphology]] in the presence of paroxysmal tachyarrhythmia.
**[[Normal]]/narrow [[QRS complex|QRS morphology]] in the presence of paroxysmal [[tachyarrhythmia]]


[[File:Lown-Ganong-Levine syndrome ECG.jpg|thumb|500px|none|Lown-Ganong-Levine syndrome ECG features. [https://upload.wikimedia.org/wikipedia/commons/b/bf/Lown-Ganong-Levine_syndrome_ECG.jpg]]]
[[File:Lown-Ganong-Levine syndrome ECG.jpg|thumb|500px|none|Lown-Ganong-Levine syndrome ECG features. [https://upload.wikimedia.org/wikipedia/commons/b/bf/Lown-Ganong-Levine_syndrome_ECG.jpg]]]
Line 421: Line 422:
===History and Symptoms===
===History and Symptoms===


*LGL syndrome is usually asymptomatic.
*LGL [[syndrome]] is usually [[asymptomatic]].
*The symptoms of LGL syndrome usually overlap with those of pre-excitation syndrome and may include the following:<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>
*The [[symptoms]] of LGL [[syndrome]] usually overlap with those of [[pre-excitation syndrome]] and may include the following:<ref name="LOWN GANONG LEVINE 1952 pp. 693–706">{{cite journal | last=LOWN | first=BERNARD | last2=GANONG | first2=WILLIAM F. | last3=LEVINE | first3=SAMUEL A. | title=The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=5 | year=1952 | issn=0009-7322 | pmid=14926053 | doi=10.1161/01.cir.5.5.693 | pages=693–706}}</ref>
 
**[[Palpitations]]
:*[[Palpitations]]
**[[Dizziness]]
:*[[Dizziness]]
**[[Lightheadedness]]
:*[[Lightheadedness]]
**[[Shortness of breath]]
:*[[Shortness of breath]]
**[[Racing heart]]
:*[[Racing heart]]
**[[Syncope]]
:*[[Syncope]]
**[[Chest pain]] or [[tachycardia]] (in case of an underlying [[cardiac]] [[Structural biology|structural]] [[defect]])
:*[[Chest pain]] or [[tachycardia]] {in case of an underlying cardiac structural defect)


===Physical Examination===
===Physical Examination===


*Patients with LGL syndrome usually appear normal.
*[[Patients]] with LGL [[syndrome]] usually [[Appearance|appear]] [[normal]].
*Physical examination findings are limited in LGL syndrome.
*[[Physical examination]] findings are limited in LGL [[syndrome]].
*During cardiac auscultation or palpation of peripheral pulses, there can be [[Irregular heart rhythms|irregular rhythm]].
*During [[cardiac]] [[auscultation]] or [[palpation]] of peripheral [[pulses]], there can be [[Irregular heart rhythms|irregular rhythm]].
 
===Laboratory Findings===
 
*There are no specific laboratory findings associated with LGL syndrome.


===Imaging Findings===
===Imaging Findings===
Line 446: Line 442:
====ECG====
====ECG====


*The diagnosis of LGL syndrome can be made by the use of resting [[The electrocardiogram|EKG]]. EKG findings usually show:
*The [[diagnosis]] of LGL [[syndrome]] can be made by the use of resting [[The electrocardiogram|EKG]]. [[EKG]] findings usually show:
**Short [[PR interval]] (<120ms)
**[[Short PR interval]] (<120ms)
**Normal [[P wave]] axis
**[[Normal]] [[P wave]] [[axis]]
**Normal/narrow [[QRS complex|QRS]] morphology in the presence of paroxysmal tachyarrhythmia.
**[[Normal]]/narrow [[QRS complex|QRS]] [[morphology]] in the presence of paroxysmal [[tachyarrhythmia]]


[[File:Lown–Ganong–Levine-syndrome-LGL.jpg|thumb|500px|none|ECG showing LGL syndrome with short PR interval, narrow QRS complex, and normal P waves. [https://litfl.com/lown-ganong-levine-syndrome/ Source: LITFL]]]
[[File:Lown–Ganong–Levine-syndrome-LGL.jpg|thumb|500px|none|ECG showing LGL syndrome with short PR interval, narrow QRS complex, and normal P waves. [https://litfl.com/lown-ganong-levine-syndrome/ Source: LITFL]]]
Line 455: Line 451:
===Other Diagnostic Studies===
===Other Diagnostic Studies===


*[[Holter monitors]] or implantable loop recorders may provide insight to the underlying conductions abnormalities.
*[[Holter monitors]] or [[Implant|implantable]] loop recorders may provide insight into the underlying [[Conduction disorders|conduction abnormalities]].


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===


*The mainstay of [[therapy]] for LGL [[syndrome]] is the use of [[Antiarrhythmic agents|antiarrhythmic]] [[medications]] to [[Prevention (medical)|prevent]] [[tachyarrhythmias]].
*The mainstay of therapy for LGL syndrome is the use of [[Antiarrhythmic agents|antiarrhythmic]] medications to prevent tachyarrhythmias.
*[[Medications]] such as [[digitalis]], [[beta-blockers]], [[calcium channel blockers]] and [[Antiarrhythmic drugs|Class I and III antiarrhythmic drugs]] have been used to [[slow]] down [[Atrioventricular node|AV]] [[Conduction System|conduction]] and [[Prevention (medical)|prevent]] [[AV reentrant tachycardia|AVRT]] and other [[arrhythmias]].<ref name="Benditt Klein Kriett Dunnigan 1984 pp. 1088–1095">{{cite journal | last=Benditt | first=D G | last2=Klein | first2=G J | last3=Kriett | first3=J M | last4=Dunnigan | first4=A | last5=Benson | first5=D W | title=Enhanced atrioventricular nodal conduction in man: electrophysiologic effects of pharmacologic autonomic blockade. | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=69 | issue=6 | year=1984 | issn=0009-7322 | pmid=6713613 | doi=10.1161/01.cir.69.6.1088 | pages=1088–1095}}</ref><ref name="Caracta Damato Gallagher Josephson 1973 pp. 245–253">{{cite journal | last=Caracta | first=Anthony R. | last2=Damato | first2=Anthony N. | last3=Gallagher | first3=John J. | last4=Josephson | first4=Mark E. | last5=Varghese | first5=P.Jacob | last6=Lau | first6=Sun H. | last7=Westura | first7=Edwin E. | title=Electrophysiologic studies in the syndrome of short P-R interval, normal QRS complex | journal=The American Journal of Cardiology | publisher=Elsevier BV | volume=31 | issue=2 | year=1973 | issn=0002-9149 | doi=10.1016/0002-9149(73)91037-0 | pages=245–253}}</ref>
*Medications such as [[digitalis]], [[beta-blockers]], [[calcium channel blockers]] and [[Antiarrhythmic drugs|Class I and III antiarrhythmic drugs]] have been used to slow down AV conduction and prevent [[AV reentrant tachycardia|AVRT]] and other arrhythmias.<ref name="Benditt Klein Kriett Dunnigan 1984 pp. 1088–1095">{{cite journal | last=Benditt | first=D G | last2=Klein | first2=G J | last3=Kriett | first3=J M | last4=Dunnigan | first4=A | last5=Benson | first5=D W | title=Enhanced atrioventricular nodal conduction in man: electrophysiologic effects of pharmacologic autonomic blockade. | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=69 | issue=6 | year=1984 | issn=0009-7322 | pmid=6713613 | doi=10.1161/01.cir.69.6.1088 | pages=1088–1095}}</ref> <ref name="Caracta Damato Gallagher Josephson 1973 pp. 245–253">{{cite journal | last=Caracta | first=Anthony R. | last2=Damato | first2=Anthony N. | last3=Gallagher | first3=John J. | last4=Josephson | first4=Mark E. | last5=Varghese | first5=P.Jacob | last6=Lau | first6=Sun H. | last7=Westura | first7=Edwin E. | title=Electrophysiologic studies in the syndrome of short P-R interval, normal QRS complex | journal=The American Journal of Cardiology | publisher=Elsevier BV | volume=31 | issue=2 | year=1973 | issn=0002-9149 | doi=10.1016/0002-9149(73)91037-0 | pages=245–253}}</ref>
*[[Drugs]] such as [[sotalol]] and [[amiodarone]] have promising [[Effect size|effects]] as a [[treatment]] option for LGL [[syndrome]] but are still under [[Investigational product|investigation]] and need further [[Study design|studies]].
*Drugs like [[sotalol]] and [[amiodarone]] are under investigations and have promising effect in LGL syndrome but needs further studies.


===Surgery===
===Surgery===
Patients refractory to medical management can be managed by the use of [[radiofrequency catheter ablation]] as it has become primary treatment in various [[pre-excitation syndrome|pre-excitation]] syndromes. This can be further implicated by the implantation of a permanent [[Artificial pacemaker|pacemaker.]]
 
*[[Patients]] [[refractory]] to [[medical]] management can be [[Managed care|managed]] by the use of [[radiofrequency catheter ablation]] as it has become a primary treatment option in various [[Pre-excitation syndrome|pre-excitation syndromes]].
*This can be further implicated by the [[implantation]] of a [[permanent pacemaker]][[Artificial pacemaker|.]]


===Prevention===
===Prevention===


*There are no primary preventive measures available for LGL syndrome.
*There are no [[Primary prevention|primary preventive]] measures available for LGL [[syndrome]].


==References==
==References==
Line 476: Line 473:
   
   
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Up-to-date]]

Latest revision as of 20:03, 28 April 2021

Lown-Ganong-Levine syndrome Microchapters

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Lown-Ganong-Levine Syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Usman Ali Akbar, M.B.B.S.[3]

Synonyms and keywords: Lown-Ganong-Levine Syndrome, LGL syndrome, Pre-excitation syndromes, Short PR Normal QRS Complex Syndrome, Clerc-Lévy-Cristesco syndrome, Coronary nodal rhythm syndrome, Short PQ interval syndrome, Short P-R syndrome.

Overview

Lown-Ganong-Levine syndrome (LGL) is actually a pre-excitation syndrome with EKG findings including short PR interval, narrow or normal QRS complex, and a normal P wave. It is caused by the presence of accessory bundles of fibers known as James fibers which lead to the development of abnormal conduction pathways. The LGL syndrome was named after Bernard Lown, William Francis Ganong, and Samual Levine who described it in 1952. Patients of LGL usually present with a history of palpitations, lightheadedness, shortness of breath, and sometimes chest pain. There is an increased risk of tachyarrhythmias and syncope. EKG is the principal modality of investigation for establishing a diagnosis. Usually, antiarrhythmics are given to prevent the development of tachyarrhythmias but recently radiofrequency ablation of the accessory pathways has been the mainstay of treatment with a good prognosis.

Historical Perspective

Historical timeline of LGL Syndrome
Year Description
1938
1946
1952
  • The Lown-Ganong-Levine (LGL) pattern was described in 1952 by Bernard Lown, William Francis Ganong, and Samual Levine.
1961-1974
  • In 1961 and subsequently, in 1974, an anatomic pathway was identified and reported by James and Brechemacher respectively.
Historic Timeline of LGL Syndrome

Classification

Accessory Pathway Description
James fibers
Brechenmacher fibers
Intra-nodal bypass tracts

Pathophysiology

LGL Syndrome associated bypass tracts

Causes

Differentiating Lown-Ganong-Levine Syndrome from other Diseases


Arrhythmia Rhythm Rate P wave PR Interval QRS Complex Response to Maneuvers Epidemiology Co-existing Conditions
LGL Syndrome
  • Present
Atrial fibrillation (AFib)[6][7]
  • Absent
Atrial flutter[8]
Atrioventricular nodal reentry tachycardia (AVNRT)[9][10][11][12]
  • Regular
Multifocal atrial tachycardia[13][14]
Paroxysmal supraventricular tachycardia
  • Regular
  • 150 and 240 bpm
  • Absent
  • Hidden in QRS
  • Absent
Premature atrial contractrions (PAC)[15][16]
  • Upright
  • Usually narrow (< 0.12 s)
_
Wolff-Parkinson-White Syndrome[17][18]
  • Regular
Ventricular fibrillation (VF)[19][20][21]
  • Absent
  • Absent
Ventricular tachycardia[22][23]
  • Regular
  • > 100 bpm (150-200 bpm common)
  • Absent

Epidemiology and Demographics

Age

  • There is currently insufficient data regarding age predilection of LGL syndrome.

Gender

  • There is currently insufficient data regarding gender predilection of LGL syndrome as the LGL pattern is not associated with an increased incidence in one particular sex.
  • However, Lown in 1952 reported 70.9% of the 34 cases in women.[1]

Race

Risk Factors

Natural History, Complications and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

Lown-Ganong-Levine syndrome ECG features. [1]

History and Symptoms

Physical Examination

Imaging Findings

ECG

ECG showing LGL syndrome with short PR interval, narrow QRS complex, and normal P waves. Source: LITFL

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 LOWN, BERNARD; GANONG, WILLIAM F.; LEVINE, SAMUEL A. (1952). "The Syndrome of Short P-R Interval Normal QRS Complex and Paroxysmal Rapid Heart Action". Circulation. Ovid Technologies (Wolters Kluwer Health). 5 (5): 693–706. doi:10.1161/01.cir.5.5.693. ISSN 0009-7322. PMID 14926053.
  2. 2.0 2.1 Manning, G W (1978). "Lown-Ganong-Levine syndrome". Circulation. Ovid Technologies (Wolters Kluwer Health). 58 (3): 576–577. doi:10.1161/01.cir.58.3.576. ISSN 0009-7322. PMID 679452.
  3. DOUGLAS, JOHN E. (1972). "Lown-Ganong-Levine Syndrome". Circulation. Ovid Technologies (Wolters Kluwer Health). 45 (5): 1143–1144. doi:10.1161/01.cir.45.5.1143. ISSN 0009-7322. PMID 5020803.
  4. 4.0 4.1 Benditt, D G; Pritchett, L C; Smith, W M; Wallace, A G; Gallagher, J J (1978). "Characteristics of atrioventricular conduction and the spectrum of arrhythmias in lown-ganong-levine syndrome". Circulation. Ovid Technologies (Wolters Kluwer Health). 57 (3): 454–465. doi:10.1161/01.cir.57.3.454. ISSN 0009-7322. PMID 624155.
  5. Denes, Pablo; Wu, Delon; Rosen, Kenneth M. (1974). "Demonstration of Dual A-V Pathways in a Patient with Lown-Ganong-Levine Syndrome". Chest. Elsevier BV. 65 (3): 343–346. doi:10.1378/chest.65.3.343. ISSN 0012-3692.
  6. Lankveld TA, Zeemering S, Crijns HJ, Schotten U (July 2014). "The ECG as a tool to determine atrial fibrillation complexity". Heart. 100 (14): 1077–84. doi:10.1136/heartjnl-2013-305149. PMID 24837984.
  7. Harris K, Edwards D, Mant J (2012). "How can we best detect atrial fibrillation?". J R Coll Physicians Edinb. 42 Suppl 18: 5–22. doi:10.4997/JRCPE.2012.S02. PMID 22518390.
  8. Cosío FG (June 2017). "Atrial Flutter, Typical and Atypical: A Review". Arrhythm Electrophysiol Rev. 6 (2): 55–62. doi:10.15420/aer.2017.5.2. PMC 5522718. PMID 28835836.
  9. Katritsis DG, Josephson ME (August 2016). "Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia". Arrhythm Electrophysiol Rev. 5 (2): 130–5. doi:10.15420/AER.2016.18.2. PMC 5013176. PMID 27617092.
  10. Letsas KP, Weber R, Siklody CH, Mihas CC, Stockinger J, Blum T, Kalusche D, Arentz T (April 2010). "Electrocardiographic differentiation of common type atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia via a concealed accessory pathway". Acta Cardiol. 65 (2): 171–6. doi:10.2143/AC.65.2.2047050. PMID 20458824.
  11. "Atrioventricular Nodal Reentry Tachycardia (AVNRT) - StatPearls - NCBI Bookshelf".
  12. Schernthaner C, Danmayr F, Strohmer B (2014). "Coexistence of atrioventricular nodal reentrant tachycardia with other forms of arrhythmias". Med Princ Pract. 23 (6): 543–50. doi:10.1159/000365418. PMC 5586929. PMID 25196716.
  13. Scher DL, Arsura EL (September 1989). "Multifocal atrial tachycardia: mechanisms, clinical correlates, and treatment". Am. Heart J. 118 (3): 574–80. doi:10.1016/0002-8703(89)90275-5. PMID 2570520.
  14. Goodacre S, Irons R (March 2002). "ABC of clinical electrocardiography: Atrial arrhythmias". BMJ. 324 (7337): 594–7. doi:10.1136/bmj.324.7337.594. PMC 1122515. PMID 11884328.
  15. Lin CY, Lin YJ, Chen YY, Chang SL, Lo LW, Chao TF, Chung FP, Hu YF, Chong E, Cheng HM, Tuan TC, Liao JN, Chiou CW, Huang JL, Chen SA (August 2015). "Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long-Term Outcome". J Am Heart Assoc. 4 (9): e002192. doi:10.1161/JAHA.115.002192. PMC 4599506. PMID 26316525.
  16. Strasburger JF, Cheulkar B, Wichman HJ (December 2007). "Perinatal arrhythmias: diagnosis and management". Clin Perinatol. 34 (4): 627–52, vii–viii. doi:10.1016/j.clp.2007.10.002. PMC 3310372. PMID 18063110.
  17. Rao AL, Salerno JC, Asif IM, Drezner JA (July 2014). "Evaluation and management of wolff-Parkinson-white in athletes". Sports Health. 6 (4): 326–32. doi:10.1177/1941738113509059. PMC 4065555. PMID 24982705.
  18. Rosner MH, Brady WJ, Kefer MP, Martin ML (November 1999). "Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: diagnostic and initial therapeutic issues". Am J Emerg Med. 17 (7): 705–14. doi:10.1016/s0735-6757(99)90167-5. PMID 10597097.
  19. Glinge C, Sattler S, Jabbari R, Tfelt-Hansen J (September 2016). "Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction". J Geriatr Cardiol. 13 (9): 789–797. doi:10.11909/j.issn.1671-5411.2016.09.006. PMC 5122505. PMID 27899944.
  20. Samie FH, Jalife J (May 2001). "Mechanisms underlying ventricular tachycardia and its transition to ventricular fibrillation in the structurally normal heart". Cardiovasc. Res. 50 (2): 242–50. doi:10.1016/s0008-6363(00)00289-3. PMID 11334828.
  21. Adabag AS, Luepker RV, Roger VL, Gersh BJ (April 2010). "Sudden cardiac death: epidemiology and risk factors". Nat Rev Cardiol. 7 (4): 216–25. doi:10.1038/nrcardio.2010.3. PMC 5014372. PMID 20142817.
  22. Koplan BA, Stevenson WG (March 2009). "Ventricular tachycardia and sudden cardiac death". Mayo Clin. Proc. 84 (3): 289–97. doi:10.1016/S0025-6196(11)61149-X. PMC 2664600. PMID 19252119.
  23. Levis JT (2011). "ECG Diagnosis: Monomorphic Ventricular Tachycardia". Perm J. 15 (1): 65. doi:10.7812/tpp/10-130. PMC 3048638. PMID 21505622.
  24. LOWN B, GANONG WF, LEVINE SA (1952). "The syndrome of short P-R interval, normal QRS complex and paroxysmal rapid heart action". Circulation. 5 (5): 693–706. doi:10.1161/01.cir.5.5.693. PMID 14926053.
  25. Benditt, D G; Klein, G J; Kriett, J M; Dunnigan, A; Benson, D W (1984). "Enhanced atrioventricular nodal conduction in man: electrophysiologic effects of pharmacologic autonomic blockade". Circulation. Ovid Technologies (Wolters Kluwer Health). 69 (6): 1088–1095. doi:10.1161/01.cir.69.6.1088. ISSN 0009-7322. PMID 6713613.
  26. Caracta, Anthony R.; Damato, Anthony N.; Gallagher, John J.; Josephson, Mark E.; Varghese, P.Jacob; Lau, Sun H.; Westura, Edwin E. (1973). "Electrophysiologic studies in the syndrome of short P-R interval, normal QRS complex". The American Journal of Cardiology. Elsevier BV. 31 (2): 245–253. doi:10.1016/0002-9149(73)91037-0. ISSN 0002-9149.