Lown-Ganong-Levine Syndrome Treatment & Management

Updated: Jan 09, 2017
  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jeffrey N Rottman, MD  more...
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Treatment

Medical Care

Because Lown-Ganong-Levine syndrome (LGL) is an outdated diagnosis, no specific therapy is indicated.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. [29] 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 paroxysmal supraventricular tachycardia (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.
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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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Activity

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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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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