Lown-Ganong-Levine syndrome

Background

• Reentrant SVT due to James fibers (atriohisian bypass tract)

Clinical Features

• Palpitations

Differential Diagnosis

Palpitations

• Arrhythmias:
  • Atrial fibrillation
  • Grouped beats on ECG (commonly misdx as A-fib)
    • Atrial bigeminy and trigeminy
    • Mobitz I or Mobitz II
  • Atrial flutter
  • SVT
  • Ventricular Tachycardia
  • Sick sinus syndrome
  • Multifocal atrial tachycardia
  • PVCs
  • Wolff–Parkinson–White syndrome (WPW)
  • Sinus node dysfunction
  • AV Block
  • Lown-Ganong-Levine Syndrome‎
  • Accelerated idioventricular rhythm
• Non-arrhythmic cardiac causes:
  • Cardiomyopathy
  • CHF
  • Mitral valve prolapse
  • Congenital heart disease
  • Pericarditis
  • Valvular disease
  • Pacemaker malfunction
  • Acute MI
• Psychiatric causes:
  • Anxiety disorder
  • Panic attack
• Drugs and Medications:
  • Alcohol
  • Caffeine
  • Meds (i.e. digitalis, theophylline)
  • Street drugs (i.e. cocaine)
  • Tobacco
• Misc
  • Hyperthyroidism

Evaluation

• ECG
  • Short PR interval
  • Normal QRS
  • No delta wave
• May appear closely to:
  • WPW
  • AV junctional rhythym

References

Authors

Jordan Swartz, Ross Donaldson, Kevin Lu, Neil Young, Daniel Ostermayer