Lenegre disease, also known as progressive cardiac conduction defect (PCCD), is described as an alteration in the cardiac conduction network [1] [2]. It is believed that this disease is caused by a mutation in the SCN5A gene in combination with age-related degeneration and fibrosis of the His-Purkinje system and its branches [3] [4]. An electrocardiogram (EKG) performed in affected individuals will reveal a conduction delay in the His-Purkinje tissues and varying degrees of arterioventricular (AV) block and differing types of branch block [5] [6]. The cardiac structure and function are typically normal in these patients.

Lenegre disease is considered as one of the most predominant conductive disturbances and is a common cause of pacemaker implantation worldwide. Moreover, it is diagnosed in patients below the age of 50 who have unexplained conduction disease but normal heart structure and likely a family history positive for Lenegre disease [7].

While some patients exhibit no symptoms, others experience dyspnea, lightheadedness, dizziness, abdominal pain, and syncope. As a result of complete AV heart block, complications such as left ventricular dilatation, heart failure, and sudden cardiac death may ensue. The latter commonly occurs in advanced cases of first-degree AV block accompanied by a bi- fascicular block as well as patients with symptomatic AV block. However, pacemaker implantation improves the prognosis significantly.

• Fatigue

  The case of a 22-year-old white male without known heart disease who presented with activity related lightheadedness at age 19 and dizziness and fatigue at age 21 is described. [scholars.northwestern.edu]

  Abstract The case of a 22-year-old white male without known heart disease who presented with activity related lightheadedness at age 19 and dizziness and fatigue at age 21 is described. [ncbi.nlm.nih.gov]

  Risks with CBD include: suicidal thoughts, suicide attempts, feelings of agitation, new or worsening depression, aggression and panic attacks in addition to liver injury, which can cause nausea, vomiting, abdominal pain, fatigue, anorexia, jaundice and [mdmag.com]

  Mobitz Type I patients may experience dizziness, fatigue, and intolerance to exercise due to the delay of the electrical impulses in the heart. [vacardio.com]

  Presentation Bradycardia may be asymptomatic but can present with syncope, fatigue or dizziness. [patient.info]

• Death in Infancy

  […] in Infancy Focus on Prolonged Repolarization 924 Sudden Cardiac Death in Kidney Diseases 934 Index 943 حقوق النشر [books.google.com]

• Heart Disease

  The case of a 22-year-old white male without known heart disease who presented with activity related lightheadedness at age 19 and dizziness and fatigue at age 21 is described. [scholars.northwestern.edu]

  The majority of these new referrals are not for congenital heart disease. [books.google.com]

  Lenegre-Lev syndrome Synonym for Atrioventricular block, complete I00-I99 Diseases of the circulatory system (I00-I99) I30-I52 Other forms of heart disease (I30-I52) I44 Atrioventricular and left bundle-branch block Results for Lenegre-Lev syndrome and [averbis.com]

  Abstract The case of a 22-year-old white male without known heart disease who presented with activity related lightheadedness at age 19 and dizziness and fatigue at age 21 is described. [ncbi.nlm.nih.gov]

• Palpitations

  Second were rhythm and rhythm related problems (inclusive of palpitations, abnormal ECG and diagnosed premature beats) constituted 19% of the total. [books.google.com]

  […] followed by the left anterior fascicle and the highly or complete atrioventricular block found in severe cases.Patients with single or double bundle branch block frequently appear asymptomatic and do not require treatment,yet may experience considerable palpitation [en.cnki.com.cn]

  NIH: National Heart, Lung, and Blood Institute Arrhythmias Atrial fibrillation or flutter Cardiac ablation procedures Cardioversion Ectopic heartbeat Electrocardiogram Exercise stress test Heart block Heart palpitations His bundle electrography Holter [icdlist.com]

  Case Presentation A 19-year-old man presented to the emergency department with palpitations and presyncope. He experienced three episodes of near complete loss of consciousness in the last few hours prior to presentation. [hindawi.com]

  Complete heart block can cause a sensation of fluttering or pounding in the chest (palpitations), shortness of breath, fainting (syncope), or sudden cardiac arrest and death.Progressive familial heart block can be divided into type I and type II, with [ncbi.nlm.nih.gov]

• Vascular Disease

  The prognostic significance of bundle branch block in high-risk chronic stable vascular disease patients: a report from the HOPE trial. J Cardiovasc Electrophysiol 2009; 20:781. Barsheshet A, Goldenberg I, Garty M, et al. [medics4medics.nl]

  Infiltrative cardiomyopathies and collagen-vascular diseases can also cause AV block. A variety of viral bacterial and parasitic etiologies of myocarditis can result in varying degrees of AV block. [thecardiologyadvisor.com]

  Research on this topic is part of the NHLBI’s broader commitment to advancing heart and vascular disease scientific discovery. Funding advances in emergency response. [nhlbi.nih.gov]

  diseases Hypoxia Musculoskeletal disorders Hypothermia Cardiothoracic surgery Increased vagal tone Valve replacement Vomiting Congenital heart disease Coughing Defecation, micturition * Most common causes. [revespcardiol.org]

• Ventricular Bigeminy

  bigeminy Ventricular bigeminy (disorder) Ventricular escape beat Ventricular escape beat (disorder) Ventricular escape rhythm Ventricular escape rhythm (disorder) Ventricular parasystole Ventricular parasystole (disorder) Ventricular rhythm All content [averbis.com]

• Dizziness

  The case of a 22-year-old white male without known heart disease who presented with activity related lightheadedness at age 19 and dizziness and fatigue at age 21 is described. [scholars.northwestern.edu]

  Abstract The case of a 22-year-old white male without known heart disease who presented with activity related lightheadedness at age 19 and dizziness and fatigue at age 21 is described. [ncbi.nlm.nih.gov]

  In the age group of interest for this book of 11-18 years, the most common presenting issues were rhythm related (23%) and chest pain (23%), followed by syncope or dizziness (19%) and heart murmur (12%). [books.google.com]

  While some patients exhibit no symptoms, others experience dyspnea, lightheadedness, dizziness, abdominal pain, and syncope. [symptoma.com]

  You may feel dizzy. Mobitz type II: The electrical signals sometimes get to the ventricles, and sometimes they do not. You may require a pacemaker, a small machine that provides regular electrical pulses to manage your heart’s rhythm. [columbiadoctors.org]

• Convulsions

  This includes convulsive and non-convulsive status epilepticus. Your child’s doctor will discuss a ‘rescue’ or emergency care plan with you to treat any prolonged or repeated seizures. [epilepsy.org.uk]

  Benzodiazepines and/or steroids may be trialled for periods of non-convulsive status. Most children are considered for advanced epilepsy management therapies such as the Modified Atkins or Ketogenic Diet or vagal nerve stimulator therapy. [epilepsyqueensland.com.au]

  […] scattered, turbulent, uncombed, broke up, anarchical, Tampered, Unarranged, topsy-turvy, shapeless, rumpled, Deracinated, distributed, Infringed, disarticulated, disconcerted, out-of-line, dislocate, untidy, Exiled, cluttered, disjunct, Messed, Pellmell, Convulsed [spellchecker.net]

  Most people with Lennox-Gastaut syndrome will have at least one episode of non-convulsive status epilepticus. Absence status epilepticus is more common in children, and may be difficult to recognize in children with severe developmental disability. [aboutkidshealth.ca]

  Absence seizures do not cause convulsions and may be so mild that they go unnoticed. They usually last only a couple to several seconds. [rarediseases.org]

Patients with the symptoms described above (such as syncope) or incidental EKG findings suggestive of a cardiac conductive defect warrant a thorough evaluation. In addition to ascertaining the personal history, the workup should include a detailed family history of diseases and manifestations such as syncope or sudden death. Patients should also undergo a complete physical exam with a focus on the cardiovascular system. Finally, affected individuals should be assessed with specific studies like electrocardiogram, echocardiogram etc.

Electrocardiogram (EKG)

Findings associated with Lenegre disease include prolonged PR interval, wide QRS complexes, right and/or left bundle branch block, as well as disturbances in other conductive tissues. An exercise stress test in patients with a complete AV block may reveal arrhythmias such as ventricular tachycardia and Torsade de Pointes.

Imaging

An echocardiogram and/or cardiac magnetic resonance imaging (MRI) are performed to assess the contractile function and structure of the heart and to rule out underlying abnormalities such as cardiomyopathy and congenital heart disease [7].

Other

Genetic testing is advised in young individuals with Lenegre disease.

• Ventricular Bigeminy

  bigeminy Ventricular bigeminy (disorder) Ventricular escape beat Ventricular escape beat (disorder) Ventricular escape rhythm Ventricular escape rhythm (disorder) Ventricular parasystole Ventricular parasystole (disorder) Ventricular rhythm All content [averbis.com]

• Third Degree Atrioventricular Block

  degree atrioventricular block Third degree block Third degree heart block Ventricular bigeminy Ventricular bigeminy (disorder) Ventricular escape beat Ventricular escape beat (disorder) Ventricular escape rhythm Ventricular escape rhythm (disorder) Ventricular [averbis.com]

  A third-degree atrioventricular block (complete heart block) was diagnosed. We believe cannabis exposure to have been the likely cause. [hindawi.com]

  Degree Atrioventricular Block (Third Degree Heart Block, Complete Heart Block) (see Third Degree Atrioventricular Block, [[Third Degree Atrioventricular Block]]) Epidemiology Fibrosis/Sclerosis of the Conduction System : accounts for 50% of cases of [mdnxs.com]

  degree atrioventricular block. a Increasing less than 100 beats/min during limited exercise test. b Not shortening with hyperventilation or limited exercise test. c A recent study suggests athletes with a QTc 500ms should be recommended not to participate [en.ecgpedia.org]

  Intermittent third-degree atrioventricular block with asystole in a patient who was admitted due to recurrent syncopes. [revespcardiol.org]

• Incomplete Right Bundle Branch Block

  right bundle branch block in the healthy young people [J];Chinese Journal of Cardiovascular Review;2008-08 Chinese Journal Full-text Database 2 Hits 1 Jihong Guo, Yuan Xu, Xuebin Li, Haicheng Zhang, Ping Zhang Peking University People's Hospital,100044 [en.cnki.com.cn]

  Lorber et al. (1988) observed a father and 2 sons with an electrocardiographic pattern of pseudo left posterior hemiblock and incomplete right bundle branch block that resulted in right axis deviation. [syndromefinder.ncchd.go.jp]

• T Wave Alternans

  Wave Alternans Mechanisms and Implications for Prediction of Sudden Cardiac Death 394 Invasive Electrophysiologic Testing Role in Sudden Death Prediction 409 Provocative Testing in Inherited Arrhythmias 424 Novel Predictors of Sudden Cardiac Death 434 [books.google.com]

  Examples of T-wave alternans from a 2-year-old long-QT syndrome patient with multiple episodes of cardiac arrest. Tracings are from a 24-hour Holter recording. [ahajournals.org]

  L-type Ca2 channel mutations and T-wave alternans: a model study. Am J Physiol Heart Circ Physiol 2007; 293 : H3480–H3489. 87. [nature.com]

• Myocardial Fibrosis

  (PDF emailed within 0-6 h: 19.90) Accession: 010735179 Download citation: RIS BibTeX Text PMID: 12598077 DOI: 10.1016/s1062-1458(03)00203-4 Mouse model of SCN5A-linked hereditary Lenègre's disease: age-related conduction slowing and myocardial fibrosis [eurekamag.com]

  Myocardial fibrosis is the most common cause. Associations: Inferior acute myocardial infarction. Sick sinus syndrome. Mobitz type II. Second-degree block plus new bundle branch or fascicular block. [patient.info]

  Mouse model of SCN5A-linked hereditary Lenegre’s disease: Age-related conduction slowing and myocardial. fibrosis. Circulation 2005;111(14): 1738–1746. PubMed CrossRef Google Scholar 36. Herfst LJ, Potet F, Bezzina CR, et al. [link.springer.com]

  The main conditions for this pattern are: (1) high degree of LAH superimposed with RBBB and (2) left ventricular hypertrophy and/or left ventricular focal block caused by myocardial fibrosis or necrosis.1,2,20 Together, these conditions neutralize the [ahajournals.org]

  Mouse model ofSCN5Alinked hereditaryLenegre sdisease: age-relatedconduction slowing and myocardial fibrosis［J］．Circulation，2005，111:1738. [12] 张海澄，昃峰. 遗传性房室传导阻滞[J]. 中国心脏起搏与心电生理杂志, 2010, 24(2): 108-110. [13] 赵翠梅,陈义汉.心脏传导阻滞的分子遗传学研究进展[J]. [doctorpda.cn]

• Abnormal ECG

  Comprehensively and expertly describes how to capture and interpret all normal and abnormal ECG findings in adults and children. [books.google.com]

  Abnormal ECG intervals including P wave duration, PR or QRS duration may be commonly observed. [aerjournal.com]

  ECG findings related to a pathological cardiac condition associated with SCD. [gmj.ir]

1. Lev M, Kinare SG, Pick A. The pathogenesis of atrioventricular block in coronary disease. Circulation. 1970;42(3):409-25.
2. Lev M, Cuadros H, Milton HP. Interruption of the atrioventricular bundle with congenital atrioventricular block. Circulation. 1971;43(5):703-10.
3. Probst V, Kyndt F, Potet F, Trochu JN, Mialet G, Demolombe S, Schott JJ, Baró I, Escande D, Le Marec H. Haploinsufficiency in combination with aging causes SCN5A-linked hereditary Lenegre disease. J Am Coll Cardiol. 2003; 41(4):643–652.
4. Schott JJ, Alshinawi C, Kyndt F, et al. Cardiac conduction defects associate with mutations in SCN5A. Nat Genet. 1999; 23(1):20–21.
5. Baruteau AE, Probst V, Abriel H. Inherited progressive cardiac conduction disorders. Curr Opin Cardiol. 2015;30(1):33-9.
6. Lev M. The pathology of complete atrioventricular block. Prog Cardiovasc Dis. 1964;6:317-26.
7. Bharati S, Lev M, Dhingra RC, et al. Electrophysiological and pathological correlations in two cases of chronic second degree atrioventricular block with left bundle branch block. Circulation. 1975;52(2):221-9.