Characteristics of atrioventricular conduction and the spectrum of arrhythmias in Lown-Ganong-Levine syndrome

Electrophysiological characteristics of atrioventricular (A-V) conduction and refractoriness were examined in 12 patients with Lown-Ganong-Levine (LGL) syndrome referred for assessment of the following arrhythmias: (group I) regular narrow QRS tachycardia 6/12 (50%), (group II) atrial fibrillation (AF) 2/12 (17%), (group III) ventricular tachycardia (VT) 4/12 (33%). A-V node refractory periods were shorter, and enhanced A-V conduction more frequent (7/12, 58% vs 7/28 25%) in LGL patients compared to similar studies in 28 normal controls. During laboratory study reciprocating tachycardia (RT) due to re-entry within the A-V node occurred in 4/12 (33%) LGL patients, and exhibited a shorter cycle length (294 ± 60.4 msec) than did the same arrhythmia in 11/28 (39%) controls (372 ± 51.8 msec, P<0.05). Similarly, RT utilizing a concealed accessory pathway had a shorter cycle length (228 ± 3.5 msec) in 2/12 (17%) LGL patients than in 11/28 (39%) controls (314 ± 24.3 msec, P<0.001). In AF, the shortest R-R intervals in 4/12 (33%) LGL patients (2 group I, 2 group II) were shorter than in 15/28 (54%) control patients (254 ± 42.2 msec vs 325 ± 64.2 msec, P<0.05). The mean R-R intervals did not differ significantly (LGL 372 ± 89 msec vs control 428 ± 82.6 msec). This study suggests that the characteristics of A-V conduction and refractoriness may permit development of more rapid heart rates during certain arrhythmias in LGL patients compared to normal controls. Furthermore, the occurrence of VT in patients with LGL syndrome indicates that symptomatic arrhythmias require specific diagnosis.