Lown-Ganong-Levine Syndrome. by Chris Nickson, Last updated January 2, OVERVIEW. bypass close to the AV node connecting the left atrium and the. Background: Lown-Ganong-Levine syndrome, includes a short PR interval, normal QRS complex, and paroxysmal tachycardia. INTRODUCTION. Lown Ganong Levine (LGL) syndrome is a rare short PR interval pre-excitation cardiac conduction abnormality, characterised by episodes of.

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Lown Ganong Levine LGL syndrome is a rare short PR interval pre-excitation cardiac conduction abnormality, characterised by episodes of palpitation, giddiness, paroxysmal tachycardia, and electrocardiograph ECG findings.

It bears an increased risk of pre- and postoperative dysrhythmias, malignant hyperthermia, and cardiac arrest. Pre-operative management of such patients is challenging for an anaesthesiologist. The key to successful management is in avoiding precipitating factors, vigilant pre-operative monitoring of dysrhythmias, and prevention and aggressive management of complications ,ong occurrence.

A year-old female patient with right subcostal pain, frequent past episodes of palpitations and giddiness, was scheduled for open cholecystectomy. She was moderately built, weighing 65 Kg, effort tolerance was 3—4 Km on levelled ground.

Airway assessment revealed Mallampatti class II with normal neck and jaw movements. Total intra-venous anaesthesia TIVA using propofol through lkng controlled infusion MCI technique with epidural for postoperative analgesia was planned.

Diagrammatic illustration of various forms of atrio-ventricular conduction associated with the presence of an anomalous pathway.

Lown–Ganong–Levine syndrome – Wikipedia

An 18G epidural catheter was secured at L2—L3. She was pre-medicated with 1 mg midazolam i. Anaesthesia was lonf by a three-step propofol infusion technique as proposed by Prys-Roberts and colleagues.

Maintenance fluid was Lactated Ringers solution administered as per calculation for the patient. Non-invasive blood pressure, heart rate, and SpO 2 were recorded intermittently following induction, intubation and thereafter at 5-minute interval along with continuous ECG monitoring. Intra-operative events including dysrhythmias were recorded. Surgery continued for 2 hours with stable haemodynamic parameters, except one paroxysm of supra-ventricular tachycardia SVT which was promptly reverted to sinus rhythm by right-hand side carotid sinus massage.


On return of effective spontaneous breathing efforts and airway reflexes, trachea was extubated. Postoperatively she remained asymptomatic and was discharged on eighth postoperative day. Pre-excitation syndrome is a short PR interval ECG abnormality in which ventricles of the heart become depolarized too early leading to premature contractions, causing arrhythmias.

LGL syndrome is one such rare type of short PR ganonf abnormality described in It is condition in which electrical impulses from sinus node take an alternate bypass tract known as James fibres arise in atria, bypass the bundle of His and join into the lower part of the AV node.

It does not end in or activate the myocardium directly leading to the absence of delta waves and facilitates reciprocal return of impulse to atria, which may initiate a reciprocating tachyarrhythmia. Lown Ganong Levine syndrome patients are prone to attacks of paroxysmal tachycardia specially supraventricular; however, syndromw episodes of atrial fibrillation are usually of short duration and rarely sustained.

It is also observed in cardiac electrophysiological disorders like AV junctional rhythms, ectopic atrial rhythms, and pre-excitation syndromes. Anaesthetic problems include various tachyarrythmias, malignant hyperthermia, and fatal cardiac outcomes.

In order to avoid these unpleasant outcomes we planned to administer total intravenous anaesthesia using propofol through manually controlled infusion technique supplemented with epidural for postoperative analgesia. Total intra-venous anaesthesia is a technique of general anaesthesia using a combination of agents given solely by intravenous route in the absence of all inhalational agents including nitrous oxide.

Since the TCI system was not available in our institution, we decided to follow the MCI system of propofol delivery through simple syringe pumps.


In the MCI regimen, the anaesthesiologist administers the required bolus dose, followed by a stepped infusion of the syndroje agent which is manually adjusted at set time intervals.

Lown–Ganong–Levine syndrome

There is paucity of published reports on anaesthetic management of patients with LGL syndrome undergoing major upper abdominal surgery. According to the experience gained, we suggest that TIVA with propofol through MCI regimen along lon other short acting agents may be a good anaesthetic choice for such patients even in peripheral hospitals when general anaesthesia is required for major upper abdominal surgical procedures.

Adequate pre-operative preparation, appropriate selection of anaesthetic agents and technique, vigilant intra-operative monitoring, avoiding factors that can trigger tachyarrythmias, malignant hyperthermia, and cardiac arrest along with good postoperative pain relief measures would go a long way in successfully managing these group of patients even in peripheral hospitals not equipped with sophisticated equipments.

National Center for Biotechnology InformationU. Med J Armed Forces India. Published online Aug 7. Author information Article notes Copyright and License information Disclaimer. Received Nov 25; Accepted Feb 2.

Lown-Ganong-Levine Syndrome

This article has been cited by other articles in PMC. Open in a separate window. Text Book of Intravenous Anaesthesia. Williams and Wilkins; Baltimore: The WPW and related syndromes; pp.

Schamroth L, Krikler DM. The problem of lone atrial fibrillation. South Af Med J.

Initial experience with total intravenous anaesthesia with propofol for elective craniotomy. Kannan S, Sherwood N. Termination of supraventricular tachycardia by propofol. Br J of Anaes. Support Center Support Gznong.

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