Lown-Ganong-Levine syndrome (LGLS) patients usually have no cardiovascular symptoms between tachycardia crisis. The ailment most often affects men [1] in their second or third decade of life [2], but signs may occur at any age and consist of rapid, regular palpitations caused by a heart rate of 200 beats per minute or more. Episodes typically begin and end suddenly, but the latter may also be perceived as gradual because the episode is followed by sinus tachycardia. Diminished cardiac output caused by the fact that diastole duration is diminished leads to lightheadedness and dyspnea. Chest pain is encountered in victims with coronary artery disease (due to the fact that coronary supply is ensured during diastole), hypertrophic cardiomyopathy or structural heart malformations, such as tricuspid atresia, Ebstein’s anomaly, mitral valve prolapse or corrected transposition of great vessels. Atrial fibrillation may be experienced in such cases, but usually, have short duration [3]. During the attack, arterial hypotension may be recorded. In advanced situations, syncope is noticed by ventricular tachycardia or ventricular fibrillation. Patients sometimes present with heart failure symptoms. The episodes may be followed by polyuria.

The frequency of the crisis tends to diminish with the advancement of age. The death risk is low, however, incidences have been recorded [4]. The demise mechanism is arrhythmic and always appears in patients that have experienced arrhythmia episodes before, so sudden death is never the first symptom [5].

Those who perceive palpitations in the cervical area are more likely to have nodal reentrant tachycardia instead of LGLS [6]. Vagal maneuvers, such as Valsalva or carotid sinus massage may block atrioventricular node conduction and stop the arrhythmia if its technique involves the node, may have no effect or temporarily slow atrioventricular conduction. This clinical response is valuable while trying to establish the process of an paroxysmal tachycardia attack [7].

• El Salvador

  El Salvador : La Libertad, San Salvador, etc. Equatorial Guinea : Malabo, etc. Eritrea : Asmara, etc. Estonia : Haapsalu, Kuressaare, Narva, Pärnu, Saaremaa, Tallinn, Tartu, etc. Ethiopia : Addis Ababa, Bahir Dar, Gondar, etc. [maria-online.com]

• Diarrhea

  Palpitation can be precipitated by vomiting or diarrhea that leads to electrolyte disorders and hypovolemia. [en.wikipedia.org]

• Tachycardia

  Found on http://www.encyclo.co.uk/local/20973 Lown-Ganong-Levine syndrome (loun´ gan´ong lә-vīn´) an electrocardiographic abnormality consisting of a short PR interval and normal QRS complex associated with paroxysmal supraventricular tachycardia. [encyclo.co.uk]

  Paroxysmal tachycardia. Arch. Int. Med. 27: 571, 1921. [johnsonfrancis.org]

  The most common tachycardias include AV nodal reentry, accessory pathway mediated tachycardia, atrial fibrillation, atrial flutter, and ventricular tachycardia. [23, 26] To date, the underlying mechanisms that generate a short PR interval in LGL have [emedicine.medscape.com]

  Lown-Ganong-Levine syndrome (LGLS) patients usually have no cardiovascular symptoms between tachycardia crisis. [symptoma.com]

• Heart Disease

  Recommended low-density lipoprotein cholesterol target level in people with heart disease <100 mg/dl Lipid profile The greatest harm in the care of these patients is the frequent attribution of coronary artery or arteriosclerotic heart disease as the [medicaljoyworks.com]

  We conclude that the abnormalities of signal conduction described in association with LGL syndrome is probably liable to be affected by some cardiac structural disease and interestingly we are reporting right side heart disease in such problem. [omicsonline.org]

  disease MANAGEMENT vagal manoeuvre’s avoid alcohol avoid coffee electrophysiological study and ablation LITFL Lown–Ganong–Levine syndrome – ECG library Bernard Lown (1921 – ) – Eponymictionary William Francis ‘Fran’ Ganong Jr. (1924 – 2007) – Eponymictionary [litfl.com]

  They are usually females, in middle life, devoid of organic heart disease and exhibit a snapping apical first heart sound. They do not demonstrate any of the features of anomalous A-V conduction. [doi.org]

• Heart Block

  Ablation of the accessory pathway is more difficult in LGL syndrome compared to WPW syndrome since it is located very close to the AV node and there is risk of causing complete heart block necessitating permanent pacemaker implantation. [healio.com]

  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]

  Verapamil plus a beta-blocker may produce complete heart block and so they should not be used together. Digoxin can also decrease conduction in the AV node. It has been used to control symptoms in pregnancy [ 5 ]. [patient.co.uk]

• Suggestibility

  Frequency distribution analyses of P-R and A-H intervals in the 65 patients demonstrated continuous unimodal functions, suggesting a continuum of A-V nodal properties. [ncbi.nlm.nih.gov]

  Theories to explain the condition have suggested possible accessory fibres that bypass all, or part of, the AV node [ 1 ]. In some cases there may be a congenitally malfunctioning AV node [ 2 ]. [patient.co.uk]

  Retrospective analysis has suggested that paroxysmal supraventricular tachycardia occurs in approximately 9.5% of patients with short PR and normal QRS duration. Genetic inheritance Unknown. A familial occurrence has been suggested. [accessanesthesiology.mhmedical.com]

• Excitement

  […] lown-ganong-levine syndrome A form of pre-excitation characterised by a short pr interval associated with a normal qrs complex. ... (12 Dec 1998) ... [encyclo.co.uk]

  Engelsk definition A form of ventricular pre-excitation characterized by a short PR interval and a normal QRS complex. [mesh.kib.ki.se]

  Convert to ICD-10-CM: 426.81 converts approximately to: 2015/16 ICD-10-CM I45.6 Pre-excitation syndrome Approximate Synonyms Lown ganong levine syndrome Clinical Information A form of ventricular pre-excitation characterized by a short pr interval and [icd9data.com]

  Free Books & Documents Excerpt Pre-excitation is a term that refers to the premature activation of the ventricles. [pubmed.ncbi.nlm.nih.gov]

  I45.6 Pre-excitation syndrome Synonyms: Accelerated atrioventricular conduction|Accelerated atrioventricular conduction (disorder)|Accessory atrioventricular conduction|Anomalous atrioventricular excitation|Anomalous atrioventricular excitation (disorder [averbis.com]

• Stroke

  Although tachycardia, along with increased stroke volume, enables cardiac output to meet demands in exercise, a very fast tachycardia is inefficient and may cause compromise. [patient.co.uk]

  Escalated stroke output. Reduced cardiac output. How Can Lown Ganong Levine Syndrome Be Diagnosed? There are several diagnostic tools for the diagnosis and confirmation of Lown Ganong Levine syndrome. Mentioned below are a few of them. [icliniq.com]

  Ventricular fibrillation - Premature contraction ( Atrial, Ventricular ) - Ectopic pacemaker - Sick sinus syndrome Other heart conditions Heart failure - Cardiovascular disease - Cardiomegaly - Ventricular hypertrophy ( Left, Right ) Cerebrovascular diseases Stroke [wikidoc.org]

• Forgetful

  Aside from the occasional palpitations that I experience (usually when I forget to take my medication), I am symptom free. [sumonova.com]

LGLS diagnosis is mainly based on electrocardiography (ECG). The criteria include a normal or inverted P wave, a short PR interval less than or equal to 0.12 second (120 ms), with normal QRS complex duration, the absence of a delta wave and presence of clinical complaints consisting of tachycardia episodes. However, QRS complexes may also be wide, if the sufferer has a preexisting or functional right bundle or left bundle branch block. A short PR interval may be seen in ectopic atrial rhythms and atrioventricular junctional rhythms [8]. When a patient describes typical supraventricular arrhythmia but normal sinus rhythm is observed on the electrocardiogram, Holter monitorization or implantable loop recorder are indicated. A Holter monitor is useful when symptoms are observed every day, whereas the other method is employed when crisis appear not as often. Obtaining an electrocardiography documentation is particularly important because it can offer important information about the mechanism of the tachycardia.

Blood tests should include serum thyroid-stimulating hormone electrolytes, calcium, and magnesium level. Further information is provided by vagal maneuvers. A carotid sinus massage can only be performed if the subject has no history of cerebrovascular events, has no carotid bruits and the blood pressure is not decreased. It should be done under blood pressure and ECG monitorization. This maneuver can terminate the episode or induce transient atrioventricular block.

A novel technique is represented by noninvasive cardiac mapping using computed-tomography scan–based three-dimensional electroimaging and 252-lead ECG [9]. When the condition becomes intolerable or when a ventricular arrhythmia is suspected, an invasive electrophysiology study is needed.

• Narrow QRS Complex

  Therefore, neither the short PR interval nor the narrow QRS complexes characterized these forms of pre-excitation. [ncbi.nlm.nih.gov]

  […] of varying amplitude No identifiable P waves, QRS complexes, or T waves Rate 150 to 500 per minute [4] [explainmedicine.com]

• Short PR Interval

  Called also short PR syndrome. [encyclo.co.uk]

  In the seminal paper Lown B et al observed that out of the 200 patients with short PR interval, 23 had paroxysmal tachycardia (11%), compared with 0.5 to 1% in a control group of 200 patients with normal PR interval. [johnsonfrancis.org]

  Engelsk definition A form of ventricular pre-excitation characterized by a short PR interval and a normal QRS complex. [mesh.kib.ki.se]

  However, none of the identified short PR interval mechanisms is necessary for the generation of LGL tachycardias. [emedicine.medscape.com]

• Third Degree Atrioventricular Block

  block ウェンケバッハ型[第]２度房室ブロック Wenckebach second degree atrioventricular block モビッツII型[第]２度房室ブロック Mobitz type II second degree atrioventricular block [第]３度房室ブロック third degree atrioventricular block 心室内ブロック intraventricular block 脚ブロック bundle branch block [jams.med.or.jp]

• Abnormal ECG

  These abnormalities are frequently seen after subarachnoid_hemorrhage (SAH) (if measured serially, almost every SAH patients has at least one abnormal ECG.), but also in subdural hematoma, ischemic CVA 's, brain Tumors, Guillain Barré, epilepsy and migraine [en.ecgpedia.org]

What Is the Treatment for Lown Ganong Levine Syndrome? Treatment of Lown-Ganong-Levine is presently focused on the utilization of antiarrhythmic drugs. [icliniq.com]

WPW Syndrome ECG Treatment of Wolff-Parkinson-White syndrome : Asymptomatic patients, showing only ECG changes do not require treatment. [doctortipster.com]

Treatment / Management Treatment of Lown-Ganong-Levine currently is centered around the use of antiarrhythmic medications and, when refractory, radiofrequency catheter ablation. [ncbi.nlm.nih.gov]

Sections Introduction Etiology Epidemiology Pathophysiology History and Physical Evaluation Treatment / Management Differential Diagnosis Prognosis Complications Consultations Deterrence and Patient Education Pearls and Other Issues Enhancing Healthcare [pubmed.ncbi.nlm.nih.gov]

Prognosis The overall prognosis of patients with LGL syndrome is good. [wikidoc.org]

Prognosis Individuals with LGL syndrome do not carry an increased risk of sudden death. [ipfs.io]

Lown-Ganong-Levine Syndrome In this article Epidemiology Presentation Investigations Management Prognosis Historical The Lown-Ganong-Levine (LGL) syndrome is one of the pre-excitation syndromes of which Wolff-Parkinson-White (WPW) syndrome is the best [patient.info]

Prognosis[edit] Individuals with LGL syndrome do not carry an increased risk of sudden death. [wikizero.com]

Sections Introduction Etiology Epidemiology Pathophysiology History and Physical Evaluation Treatment / Management Differential Diagnosis Prognosis Complications Consultations Deterrence and Patient Education Pearls and Other Issues Enhancing Healthcare [pubmed.ncbi.nlm.nih.gov]

Etiology Some evidence suggests that LGL is a hereditary condition in some families. No definitive structural/anatomic anomaly has been identified as yet. [clinicalgate.com]

[…] of palpitations is long, and in some cases, the etiology is unable to be determined.[1] In one study reporting the etiology of palpitations, 43% were found to be of cardiac etiology, 31% of psychiatric etiology and approximately 10% were classified as [en.wikipedia.org]

Therefore, most consider the disorder to be a clinical syndrome with multiple different underlying etiologies, all involving some form of intranodal or paranodal fibers that bypass all or part of the atrioventricular (AV) node with subsequent conduction [ipfs.io]

Tricuspid regurgitation is functional and is a satellite of left-sided heart disease and/or elevated pulmonary artery pressure most of the time; and when progressive, it worsens the patient prognosis whatever the underlying etiology [10]. [omicsonline.org]

Sections Introduction Etiology Epidemiology Pathophysiology History and Physical Evaluation Treatment / Management Differential Diagnosis Prognosis Complications Consultations Deterrence and Patient Education Pearls and Other Issues Enhancing Healthcare [pubmed.ncbi.nlm.nih.gov]

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 [wikidoc.org]

Young JB; American Heart Association; Council on Clinical Cardiology, Heart Failure, and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; Council on Epidemiology [doi.org]

Epidemiology Lown suggested that 17% of people with a PR interval of less than 120 ms would have the condition[3]. It is however very rare, with prevalence estimated to be less than one in a million[4]. [patient.info]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]

The pathophysiology of this syndrome includes an accessory pathway connecting the atria and the atrioventricular (AV) node (James fiber), or between the atria and the His bundle (Brechenmacher fiber). [ncbi.nlm.nih.gov]

Pathophysiology Unlike WPW syndrome, the pathophysiology underlying LGL syndrome is poorly understood. The syndrome was once thought to involve an accessory pathway (bundle of James) that connects the atria directly to the bundle of His. [ipfs.io]

Prevention There are no primary preventive measures available for LGL syndrome. References ↑ 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). [wikidoc.org]

Statement from the Council on Clinical Cardiology, Heart Failure, and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention [doi.org]

The key to successful management is in avoiding precipitating factors, vigilant pre-operative monitoring of dysrhythmias, and prevention and aggressive management of complications on occurrence. [ncbi.nlm.nih.gov]

Bernard Lown was a founder of International Physicians for the Prevention of Nuclear War and, in 1985, the group was awarded the Nobel Prize for Peace. He developed the direct current defibrillator. [patient.co.uk]

Arrhythmic chronic treatment, designed to prevent crisis of ventricular tachycardia and to control ventricular rate in case of atrial fibrillation is realized by the administration of class IC antyarrhythmics (flecainide, propafenone), class III antiarrhythmics [doctortipster.com]

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2. Tada H, Oral H, Greenstein R, et al. Analysis of age of onset of accessory pathway-mediated tachycardia in men and women. Am J Cardiol. 2002;89:470-1.
3. Sharma MK, Misra S. Anaesthetic management of a patient with Lown-Ganong-Levine syndrome – a case report. Med J Armed Forces India. 2011;67(3):285-7.
4. Santinelli V, Radinovic A, Manguso F, et al. Asymptomatic ventricular preexcitation: a long-term prospective follow-up study of 293 adult patients. Circ Arrhythm Electrophysiol. 2009;2:102-7.
5. Santinelli V, Radinovic A, Manguso F, et al. The natural history of asymptomatic ventricular pre-excitation a long-term prospective follow-up study of 184 asymptomatic children. J Am Coll Cardiol. 2009;53:275-80.
6. González-Torrecilla E, Almendral J, Arenal A, et al. Combined evaluation of bedside clinical variables and the electrocardiogram for the differential diagnosis of paroxysmal atrioventricular reciprocating tachycardias in patients without pre-excitation. J Am Coll Cardiol. 2009;53:2353-8.
7. Marchlinski FE. Diagnosing the mechanism of supraventricular tachycardia: restoring the luster of a fading art. J Am Coll Cardiol. 2009;53:2359-61.
8. Mackenzie R. Short PR interval. J Insur Med. 2005;37:145–152.
9. Shah A, Hocini M, Haissaguerre M, Jaïs P. Non-invasive mapping of cardiac arrhythmias. Curr Cardiol Rep. 2015;17(8):60.