Lown-Ganong-Levine Syndrome. by Chris Nickson, Last updated January 2, OVERVIEW. bypass close to the AV node connecting the left atrium and the. Background: Lown-Ganong-Levine syndrome, includes a short PR interval, normal QRS complex, and paroxysmal tachycardia. INTRODUCTION. Lown Ganong Levine (LGL) syndrome is a rare short PR interval pre-excitation cardiac conduction abnormality, characterised by episodes of.

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Diagnostic criteria include PR interval of no more than ms, normal QRS complex duration, and paroxysmal supraventricular tachycardia PSVT but not atrial fibrillation or levind.

Anaesthetic management of a patient with Lown Ganong Levine syndrome—a case report

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. Total intra-venous anaesthesia TIVA using propofol through manually controlled infusion MCI technique with epidural for postoperative analgesia was planned. Author information Article notes Copyright and License information Disclaimer.

Background Lown-Ganong-Levine syndrome, with the electrocardiographic ECG findings of a short PR interval, a normal QRS complex, and paroxysmal shndrome, was first described in [ 1 ], and was further characterized by Lown, Ganong, and Levine in [ 2 ]. Tachycardia reduces the duration of both systole and diastole but it is diastole that is reduced more.

A year-old female patient with right subcostal pain, frequent past episodes of palpitations and giddiness, was scheduled for open cholecystectomy.

Where arrhythmias have been investigated in people with the diagnostic criteria, another cause has often been found. During an attack the pulse rate may be beats per minute or sometimes even higher. However, EP studies have been unable to identify a single accessory pathway or structural abnormality levinw all individuals with LGL syndrome. The problem of lone atrial fibrillation. Learn how your comment data is processed.

Anaesthetic management of a patient with Lown Ganong Levine syndrome—a case report

AV nodal Wenckebach block occurred at atrial pacing cycle length of ms. This article is for Medical Professionals. A repeat adenosine challenge, at the agnong dose, resulted in transient AV conduction block. Morphology of the human atrioventricular node, with remarks pertinent to its electrophysiology.


The retrograde ventriculoatrial VA conduction had decremental properties.

Support Center Support Center. This page was last edited on 9 Decemberat An electrophysiologic study showed an unusually short atrial to His AH conduction interval and a normal His to ventricle HV interval, without a delta wave.

You can opt out at any time or find out more by reading our cookie policy. Hence, there is less time to perfuse the myocardium at a time of increased metabolic need.

Lown–Ganong–Levine syndrome – Wikipedia

Instead, the retrograde slow AV nodal pathway was eventually ablated successfully at the right lower mid septal area above the fanong sinus ostium. If the James fiber had retrograde AV conduction, it would have been possible to also evaluate the anatomical difference in the atrial insertion site between the James fiber and the fast AV nodal pathway.

Kannan Gnong, Sherwood N. Initial experience with total intravenous anaesthesia with propofol for elective craniotomy. South Af Med J. 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.

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 ]. In this case, since this pathway had some decremental properties, it is possible that the distal insertion site of this pathway was in the distal AV nodal area James fiber rather than connecting via the atria and the His bundle Brechenmacher fiber [ 34 ].

Observations regarding the pathophysiology of the Lown-Ganong-Levine syndrome.

The occurence of frequent paroxysms of tachycardia in patients with a short PR interval and normal QRS duration had been described by Clerc et al in but it was the Americans who achieved the immortality of an eponym. Health Tools Feeling unwell?


His one great achievement is being the father of two amazing children. Characteristics of atrioventricular conduction and the ayndrome of arrhythmias in Lown-Ganong-Levine syndrome.

Br J of Anaes. Individuals with LGL syndrome do not carry an increased risk of sudden death.

Lown–Ganong–Levine syndrome

The pathophysiology of this syndrome includes an accessory pathway connecting the atria and the atrioventricular AV node James fiberor between the atria and the His bundle Brechenmacher fiber.

Cryoablation commenced at the level of the mid-coronary sinus ostium and continued superiorly, finally eliminated the retrograde slow AV nodal pathway at the right lower midseptal area above the coronary sinus ostium.

Since the tachycardia in this case was caused by fast and slow AV nodal re-entrant tachycardia and the antegrade effective refractory period of the James fiber was relatively long msin retrospect, there may have been no need to ablate the James fiber in this case. From Wikipedia, the free encyclopedia. It does not end in or activate the myocardium directly leading to the absence of delta waves and facilitates reciprocal return of impulse to atria, which may initiate syndroms reciprocating tachyarrhythmia.

When decremental conduction occurred, this pathway showed no response to the adenosine challenge, and ganonh this pathway became intermittent, there was a paradoxical response to adenosine challenge with conduction via a short AH instead of lengthening AH or conduction block.

The condition was first described in before the advent of electrophysiological testing, and some people dispute its existence as an entity. However, subsequent studies have shown that a short PR interval in the absence of symptomatic tachycardia is simply a benign EKG variant.