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Lown-Ganong-Levine Syndrome Treatment & Management

  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jeffrey N Rottman, MD  more...
 
Updated: Dec 30, 2015
 

Medical Care

Because LGL is an outdated diagnosis, no specific therapy is indicated. In the acute setting of tachycardia, the goals of medical care include identifying the cause of tachycardia and, in symptomatic cases, controlling the ventricular rate. Treatment should be based on the cause of tachycardia. As with any tachycardia, hospitalization is warranted in cases of hemodynamic instability.

To summarize:

  • Admit patients in unstable condition to telemetry.
  • Institute pharmacologic therapy as dictated by symptoms and documented tachycardia.
  • Obtain a cardiology consultation. (See Consultations.)
  • Consider exercise treadmill testing if tachycardia is induced by exercise.

In the outpatient setting, empiric therapies for recurrent PSVT may be instituted. These therapies may include beta-blockers, calcium channel blockers, and digoxin. A full discussion of these therapies lies outside the scope of this article (see Paroxysmal Supraventricular Tachycardia).

Further outpatient care includes the following:

  • If no arrhythmia is documented on ECG or telemetry, and symptoms occur on a daily basis, consider Holter monitor with diary to document cardiac rhythm during symptomatic episodes.
  • If no arrhythmia is documented on ECG or telemetry, and symptoms occur less frequently than daily, consider an event recorder to document cardiac rhythm during symptomatic episodes.
  • If patient is in stable condition and does not require hospitalization, and if no tachyarrhythmia has been documented but symptoms are induced by exercise, consider outpatient exercise treadmill testing.
  • If symptoms persist, but no tachyarrhythmia can be documented by any of these methods, consider referral to an electrophysiologist for an outpatient EP study.

Diet and activity

No dietary restrictions are required. 

Patients who have experienced an episode of syncope should be counseled to not drive or operate vehicles of public transport for 6 months from the time of the most recent episode of syncope, or until the cause of syncope has been identified and adequately treated.

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Surgical Care

Rare patients for whom the criteria of LGL are met may have no inducibility of tachyarrhythmias by EP study. Rarely, medical therapy fails in these patients, who continue to have recurrent, intolerable symptoms. In such extreme cases, pacemaker implantation, followed by radiofrequency (RF) ablation of the AV node or bundle of His may be considered.

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Consultations

An immediate cardiology consultation is warranted if the patient has presyncope, syncope, hypotension with tachycardia, angina, or other evidence of instability at the time of evaluation.

Conditions appropriate for consideration of RF catheter ablation and referral to an electrophysiologist include the following:

  • Failure of pharmacologic therapy to control symptoms
  • Recurrence of any signs of hemodynamic instability or of intolerable symptoms under medical management
  • Patient's desire to avoid daily medication
  • Intolerable adverse effects of medication
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Contributor Information and Disclosures
Author

Daniel M Beyerbach, MD, PhD Medical Director, Cardiac Rhythm Program, The Christ Hospital; Affiliate Clinical Assistant Professor of Biomedical Science, Florida Atlantic University

Daniel M Beyerbach, MD, PhD is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher Cadman, MD Decatur Memorial Hospital Heart and Lung Institute

Christopher Cadman, MD is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Frank M Sheridan, MD 

Frank M Sheridan, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD Professor of Medicine, Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine; Cardiologist/Electrophysiologist, University of Maryland Medical System and VA Maryland Health Care System

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association, Heart Rhythm Society

Disclosure: Nothing to disclose.

Additional Contributors

Justin D Pearlman, MD, ME, PhD, FACC, MA Chief, Division of Cardiology, Director of Cardiology Consultative Service, Director of Cardiology Clinic Service, Director of Cardiology Non-Invasive Laboratory, Chair of Institutional Review Board, University of California, Los Angeles, David Geffen School of Medicine

Justin D Pearlman, MD, ME, PhD, FACC, MA is a member of the following medical societies: American College of Cardiology, International Society for Magnetic Resonance in Medicine, American College of Physicians, American Federation for Medical Research, Radiological Society of North America

Disclosure: Nothing to disclose.

Acknowledgements

Christopher Cadman, MD, contributed to the original version of this article.

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ECG demonstrating a short PR interval of approximately 100 ms and normal QRS.
ECG demonstrating ventricular preexcitation. A delta wave, which corresponds to initial myocardial depolarization via a bypass tract, appears at the beginning of each QRS complex.
 
 
 
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