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
- Bundle of James accessory pathway creates atrio-hisian bypass tract
Clinical Features
- Palpitations
- Paroxysmal supraventricular tachycardia
- Short PR interval on ECG
Differential Diagnosis
Narrow-complex tachycardia
- Regular
- AV Node Independent
- Sinus tachycardia
- Atrial tachycardia (uni-focal or multi-focal)
- Atrial fibrillation
- Atrial flutter
- Idiopathic fascicular left ventricular tachycardia
- AV Node Dependent
- AV Node Independent
- Irregular
- Multifocal atrial tachycardia (MAT)
- Sinus tachycardia with frequent PACs, PJCs, PVCs
- Atrial fibrillation
- Atrial flutter with variable conduction
- Digoxin Toxicity
Palpitations
- Arrhythmias:
- Non-arrhythmic cardiac causes:
- Psychiatric causes:
- 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