Lown-Ganong-Levine syndrome

Background

Poorly understood pre-excitation condition
Atrioventricular re-entrant tachycardia (AVRT) due to James fibers
- Bundle of James accessory pathway creates atrio-hisian bypass tract
  - Convincing existence of the James accessory pathway has not been conclusively demonstrated

Clinical Features

Differential Diagnosis

Narrow-complex tachycardia

Regular
- AV Node Independent
  - Sinus tachycardia
  - Atrial tachycardia (uni-focal or multi-focal)
  - Atrial fibrillation
  - Atrial flutter
- AV Node Dependent
  - Paroxysmal supraventricular tachycardia (PSVT)
    - AV node re-entry tachycardia (AVNRT)
    - AV re-entry tachycardia (AVRT)
      - Lown-Ganong-Levine syndrome
      - Wolff–Parkinson–White syndrome
  - Junctional tachycardia
Irregular
- Multifocal atrial tachycardia (MAT)
- Sinus tachycardia with frequent PACs
- Atrial fibrillation
  - Atrial fibrillation with RVR
- Atrial flutter with variable conduction

Palpitations

Arrhythmias:
Non-arrhythmic cardiac causes:
Psychiatric causes:
- Panic attack
- Anxiety
- Somatic Symptom Disorder
Drugs and Medications:
- Alcohol
- Caffeine
- Drugs of abuse (e.g. cocaine)
- Medications (e.g. digoxin, theophylline)
- Tobacco
Misc

Evaluation

ECG
- Short PR interval
- Normal QRS
- No delta wave
- May have ventricular premature complexes
May appear similar to:
- WPW
- AV junctional rhythm

Management

Vagal manoeuvres may terminate episodes of SVT
Counsel to avoid alcohol, coffee, and other stimulants
Patients with demonstrated accessory pathways on electrophysiological study may benefit from ablation

Disposition

Home with cardiology follow up
Consider referral for Holter monitor, echo to rule out structural disease, and electrophysiologic studies

See Also

References

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