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].

• Turkish

  Kuşadası, Kütahya, Lara, Mahmutlar, Manavgat, Manisa, Marmaris, Mersin, Muğla, Nevşehir, Olympos, Palandöken, Pamukkale, Prince Islands, Samsun, Sapanca, Sarigerme, Sarıkamış, Selimiye, Selçuk, Side, Tarsus, Tekirova, Trabzon, Troy, Turgutlu, Turgutreis, Turkish [maria-online.com]

• Burkina Faso

  Burkina Faso : Bobo-Dioulasso, Ouagadougou, etc. Burundi : Bujumbura, etc. Cambodia : Angkor, Battambang, Kampot, Kep, Phnom Penh, Siem Reap, Sihanoukville, etc. Cameroon : Bafoussam, Bamenda, Douala, Garoua, Kribi, Limbe, Maroua, Yaoundé, etc. [maria-online.com]

• Euthyroid

  She was euthyroid; ECG revealed regular rhythm with inverted P waves, short PR interval, absent delta waves with normal QRS morphology (Figure 1). Diagnosed as a case of LGL syndrome and put on tab atenolol 50 mg OD. [ncbi.nlm.nih.gov]

• Tachycardia

  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]

  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]

  In three patients the atrium did not appear necessary to sustain supraventricular tachycardia. [ncbi.nlm.nih.gov]

• 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 cause [medicaljoyworks.com]

  Lown Ganong Levine syndrome Symptoms Here are the list of Lown Ganong Levine syndrome Symptoms: palpitations lightheadedness shortness of breath heart disease or coronary artery disease cardiac stress chest pain [diseasesatoz.com]

  […] palpitations collapse INVESTIGATIONS ECG: - very short PR intervals - sinus rhythm with ventricular extrasystoles - no delta wave (how to differentiate from WPW) - normal QRS Holter monitor: - frequency and severity of attacks ECHO: to rule out structural heart [litfl.com]

  Lown Ganong Levine syndrome Synonym for Pre-excitation syndrome I00-I99 Diseases of the circulatory system (I00-I99) I30-I52 Other forms of heart disease (I30-I52) I45 Other conduction disorders Results for Lown Ganong Levine syndrome and additional synonyms [averbis.com]

  In the absence of significant structural heart disease, the mortality rate appears to be very low. Clinical History Symptoms of paroxysmal tachycardia may be elicited. [odlarmed.com]

• Carotid Bruit

  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. [symptoma.com]

• Cesarean Section

  Post by: 3:35PM Dec 22, 2018 Comments off CASE REPORT Med-Science. 2018; 7(4): 951-2 doi: 10.5455/medscience.2018.07.8875 Anesthesia management in cesarean section with lown ganong levine syndrome Duygu Demiroz Aslan; Fusun Adam; Neslihan Altunkaya. [medicinescience.org]

  Anesthesia management in cesarean section with lown ganong levine syndromeDuygu Demiroz Aslan, Fusun Adam, Neslihan Altunkaya. [bibliomed.org]

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.

• Short PR Interval

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

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

  Those with LGL syndrome have episodes of abnormal heart racing with a short PR interval and normal QRS complexes seen on their electrocardiogram when in a normal sinus rhythm. [en.wikipedia.org]

  From Wikidata Jump to navigation Jump to search syndrome that involves pre-excitation of the ventricles due to an accessory pathway providing an abnormal electrical communication from the atria to the ventricles atrial tachyarrhythmia with short PR interval [wikidata.org]

• Inverted P Wave

  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. [symptoma.com]

  Diagnostic criteria include PR interval of no more than 120 ms, normal QRS complex duration, a normal or inverted P wave, and paroxysmal supraventricular tachycardia (PSVT) but not atrial fibrillation or flutter. [patient.co.uk]

  She was euthyroid; ECG revealed regular rhythm with inverted P waves, short PR interval, absent delta waves with normal QRS morphology (Figure 1). Diagnosed as a case of LGL syndrome and put on tab atenolol 50 mg OD. [ncbi.nlm.nih.gov]

• Ischemic Changes

  His ECG does not show typical ischemic changes. Patients with stable angina may have normal ECGs during the angina-free period. [metealpaslan.com]

1. Rodriguez LM, De Chillou C, Schläpfer J, et al. Age at onset and gender of patients with different types of supraventricular tachycardias. Am J Cardiol. 1992;70:1213-5.
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.