Lown-Ganong-Levine Syndrome

Report:

Sinus rhythm 65/min

LGL conduction

PR interval 0.10”

Borderline inferior T wave changes

Comment:

The commonly accepted explanation for the short PR interval is partial or complete AV nodal bypass by paranodal fibres inserting into the bundle of His. The term syndrome, as with WPW syndrome, should be reserved for those that develop supraventricular tachyarrhythmias.

This patient has the syndrome. One of her SVTs is shown below. It looks like common or garden SVT at 160/min – not fast enough to suggest a bypass tract; it needn’t be. There is electrical alternans, best seen in V2-3, of no clinical significance. Finally, there are pseudo-R’ waves in V1, suggesting AV nodal reentry mechanism25. There is no reason to think that every SVT in this syndrome depends on the paranodal fibres as part of the reentry circuit.

Fig 146a. SVT.

Fig 47. Demented 90 year old lady, transferred from nursing home for urinary tract infection.

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