Lown-Ganong-Levine Syndrome. by Chris Nickson, Last updated January 2, OVERVIEW. bypass close to the AV node connecting the left atrium and the. However, most lack the histopathologic correlation that has been demonstrated for the WPW syndrome. The Lown-Ganong-Levine (LGL). Background: Lown-Ganong-Levine syndrome, includes a short PR interval, normal QRS complex, and paroxysmal tachycardia.

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Case Report A year-old man presented to our institution with a history of recurrent narrow-complex and wide-complex tachycardia. The clinical and electrophysiologic features of a case of recurrent narrow-complex and wide-complex tachycardia on electrocardiogram ECGin a year-old man, are presented.

Lown–Ganong–Levine syndrome

Ventricular pre-excitation in children and young adults. D ICD – LGL syndrome is one such rare type of short PR interval abnormality described in No such pathway has been identified for LGL. Instead, the retrograde slow AV nodal pathway was eventually ablated successfully at the right lower mid septal area above the coronary sinus ostium.

Adequate pre-operative preparation, appropriate selection of anaesthetic agents and technique, vigilant intra-operative monitoring, avoiding factors that can trigger tachyarrythmias, malignant hyperthermia, and cardiac arrest along with good postoperative pain relief measures would syndromr a long way in successfully managing these group of patients even in peripheral hospitals not equipped with sophisticated equipments.

Ina clinical study of children and young adults included cases of sudden death, in which out of ten cases of ventricular pre-excitation 3. AV nodal Wenckebach block occurred at atrial pacing cycle length of ms. At pacing cycle length ms with stable 1: Your email address will not be published. Bernard Lown was born inWilliam Ganong was born and Samuel Albert Levine was born in and died in Williams and Wilkins; Baltimore: Received Nov 25; Accepted Feb 2.

Diagnostic criteria include PR interval of no more than ms, normal QRS complex duration, and paroxysmal supraventricular tachycardia PSVT but not atrial fibrillation or flutter. Initial experience with total intravenous anaesthesia with propofol for elective craniotomy. In the recovery curve study, this pathway had a flat conduction curve without an AH increase until the last 60 ms, before reaching the effective refractory period.


Catheter manipulation at the upper mid-septal area incidentally resulted in transient AH prolongation mechanical ablation of the James fiber. Med Syjdrome Armed Forces India. In the two cases of Lown-Ganong-Levine syndrome, one case had a hypoplastic atrioventricular node, likely to have been caused by EAVNC, and the other had Brechenmacher fibers atrio-Hisian tracts ; of the cases of Wolff-Parkinson-White syndrome, sudden cardiac death was related to a very short ante-grade effective refractory period of the accessory pathway [ 8 ].

Author information Article notes Copyright and License information Syndome. This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Theories to explain the condition have suggested possible intranodal or paranodal fibres that bypass all, or part of, the AV node. Therefore, the pre-James fiber ablation curve was a hybrid of a James fiber and a slow AV nodal pathway conduction curve; the post-James fiber ablation curve was a hybrid of fast and slow AV nodal conduction curve, and the post-slow pathway ablation curve was a hybrid of the James fiber and fast AV nodal syndome curve.

In this case of Lown-Ganong-Levine syndrome, electrophysiologic studies supported the role of the accessory pathway of James fibers. On his recent hospital admission, the electrophysiologic studies showed an extremely short baseline atrial to His AH conduction interval of 22 ms, and a normal His to ventricle HV interval, without a delta wave Figure 2.

Anaesthetic problems tanong various tachyarrythmias, malignant hyperthermia, and fatal cardiac outcomes. Find articles by John Cogan. The condition was first described in before the advent of electrophysiological testing, and some people dispute its existence as an entity. Termination of supraventricular tachycardia by propofol.

Finally, catheter ablation at the AV nodal region resulted in a normalized AH interval, normal decremental conduction, and resulted in a positive response to adenosine challenge. Cardiovascular disease heart I00—I52— The James fiber in this patient appeared to be a bystander, which was not a tachycardia substrate. A year-old female patient with right subcostal pain, frequent past episodes of palpitations and giddiness, was scheduled for open cholecystectomy.

Similar features are seen in enhanced atrioventricular nodal conduction EAVNCwith elvine underlying pathophysiology due to a fast pathway to the AV node, and with the diagnosis requiring specific electrophysiologic criteria.


From A1A2 gankng the two recovery curves were superimposable, and this was presumed to be the James fiber effective refractory period.

Lown–Ganong–Levine syndrome – Wikipedia

In this case, the clinical and electrophysiologic characteristics were consistent with a diagnosis of Lown-Ganong-Levine syndrome, with a short PR interval, normal QRS complex, without a delta wave, and paroxysmal tachycardia.

Learn how your comment data is processed. However, subsequent studies have shown that a short PR interval in the absence of symptomatic tachycardia is simply a benign EKG variant. We use cookies to understand site usage and to improve the content and offerings on our sites.

According to the experience gained, we suggest that TIVA with propofol through MCI regimen along with other short acting agents may be a good anaesthetic choice for such patients even in peripheral hospitals when general anaesthesia is required for major upper abdominal surgical procedures. The syndrome can produce ventricular fibrillation and sudden death. A year-old man presented with a history of recurrent narrow-complex and wide-complex tachycardia on electrocardiogram ECG.

In ventricular extrastimuli, the VA conduction progressively lengthened to ms, then jumped to ms, with the earliest retrograde atrial conduction that shifted to the coronary sinus ostium, which induced a retrograde, slow-antegrade, fast AV nodal re-entry.

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Pre-excitation syndrome is a short PR interval ECG abnormality in which ventricles of the heart become depolarized too early leading to premature contractions, causing arrhythmias. An 18G epidural catheter was secured at L2—L3. He created the ‘Critically Ill Airway’ course and teaches lrvine numerous courses around the world.

However, EP studies have been unable to identify a single accessory pathway or structural abnormality in all individuals with LGL syndrome. Author information Article notes Copyright and License information Disclaimer. Maintenance fluid was Lactated Ringers solution administered as per calculation for the patient.