Lown-Ganong-Levine Syndrome Workup

  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jeffrey N Rottman, MD   more...
 
Updated: Jan 4, 2012
 

Laboratory Studies

  • Workup is directed at determining the cause of tachycardia. LGL is an outdated diagnosis, and as such no workup is directed at making this diagnosis. However, identification of a short PR interval during sinus rhythm in a patient with paroxysmal supraventricular tachycardia (PSVT) should raise suspicion of a possible underlying bypass tract (ie, WPW). In the case of isolated short PR interval with no history of tachycardia or symptoms suggestive of paroxysms of tachycardia, no further workup is indicated.
  • Patients may present in an acute episode of tachycardia or with a history of symptoms suggestive of paroxysms of tachycardia.
    • In the acute setting, institute a standard workup for tachycardia, including an ECG to document the rhythm, serum electrolytes, calcium, magnesium levels, and serum thyroid-stimulating hormone (TSH) levels.
    • For a history suggestive of recurrent paroxysms of tachycardia, a Holter monitor or event recorder may prove useful for documenting the rhythm during acute symptomatic episodes. Less commonly, particularly when paroxysms of tachycardia are more rare, an implantable loop recorder may prove helpful.
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Imaging Studies

  • In the case of shortness of breath, posteroanterior and lateral chest films are indicated.
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Other Tests

To meet criteria for LGL, the 12-lead ECG taken during a period of normal sinus rhythm must demonstrate a PR interval less than or equal to 0.12 second and a normal QRS upstroke and duration, as in the image below.

ECG demonstrating a short PR interval of approximaECG demonstrating a short PR interval of approximately 100 ms and normal QRS.

One of the most useful diagnostic tools is a 12-lead ECG recorded during a paroxysm of tachycardia. Such documentation satisfies the LGL criterion of tachycardia.

A delta wave on the QRS complex precludes the diagnosis of LGL, because one of the criteria for LGL is a normal QRS complex. A delta wave suggests the presence of an accessory pathway; occurrence of supraventricular tachycardia in the presence of an accessory pathway suggests WPW, another preexcitation syndrome, as in the image below.

ECG demonstrating ventricular preexcitation. A delECG 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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Procedures

  • If tachycardia is present, diagnostic workup to determine the cause may include Valsalva maneuvers.
  • If blood pressure is stable, the patient has no angina, is not presyncopal, and no carotid bruits are present, carotid massage may provide diagnostic information. Ideally, carotid massage should be performed during continuous 12-lead rhythm strip monitoring. The result of carotid massage may be termination of the tachycardia, or transient AV block that may provide a ventricular pause long enough to reveal an underlying atrial arrhythmia.
  • If these maneuvers fail to terminate the tachycardia, a trial of intravenous adenosine administration, again with simultaneous rhythm strip recording, may reveal the rhythm. Adenosine should not be administered if there is any indication of pre-excitation on the surface ECG.
  • In cases of recurrent tachycardia, an invasive electrophysiology study is warranted. This is particularly true when symptoms become intolerable, medical therapy is failing to prevent episodes of tachycardia, or when a ventricular arrhythmia is suspected.
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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  Director of Arrhythmia Service, Assistant Professor, Department of Internal Medicine, Division of Cardiology, University of New Mexico

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Director of Cardiology Quality Program KMC, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School

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

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Frank M Sheridan, MD  Cardiology, Providence Everett Medical Center

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

Disclosure: Nothing to disclose.

Amer Suleman, MD  Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD  Professor of Medicine and Pharmacology, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)

Disclosure: Nothing to disclose.

Additional Contributors

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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