What is the role of ECG in the workup of Lown-Ganong-Levine syndrome (LGL)?

Updated: Dec 09, 2020
  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jose M Dizon, MD  more...
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Answer

Electrocardiography

A resting electrocardiogram is needed for the diagnosis of Lown-Ganong-Levine (LVL) syndrome, in which the PR interval is short but the QRS interval is normal. [1]

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.

Lown-Ganong-Levine Syndrome. Electrocardiogram dem Lown-Ganong-Levine Syndrome. Electrocardiogram 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.

Noninvasive mapping of cardiac arrhythmias is also possible with a 252-lead ECG and computed-tomography scan–based three-dimensional electroimaging. [29]

Lown-Ganong-Levine Syndrome. Electrocardiogram dem Lown-Ganong-Levine Syndrome. Electrocardiogram 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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