{"id":10043,"date":"2026-04-01T07:03:40","date_gmt":"2026-04-01T07:03:40","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10043"},"modified":"2026-04-09T07:23:02","modified_gmt":"2026-04-09T07:23:02","slug":"trace-1-1-bloc-auriculo-ventriculaire-du-premier-degre","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-1-1-bloc-auriculo-ventriculaire-du-premier-degre\/","title":{"rendered":"Trac\u00e9 1.1: Bloc auriculo-ventriculaire du premier degr\u00e9"},"content":{"rendered":"","protected":false},"featured_media":10042,"template":"","ecg_case_type":[250],"language_ecgcase":[259],"class_list":["post-10043","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-atrioventricular-block","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 1.1: Bloc auriculo-ventriculaire du premier degr\u00e9","patient_description":"Homme de 63 ans, asymptomatique, \u00e9lectrocardiogramme de contr\u00f4le","quiz_question":"Concernant cet ECG, quelle(s) est(sont) la(les) r\u00e9ponse(s) vraie(s)?","quiz_answer_1":"le rythme est sinusal","quiz_answer_2":"il existe une dysfonction sinusale","quiz_answer_3":"l\u2019activit\u00e9 atriale est r\u00e9trograde","quiz_answer_4":"il existe un BAV du premier degr\u00e9","quiz_answer_5":"il existe une pr\u00e9-excitation ventriculaire sur voie accessoire","correct_answer":["A","D"],"ecg_image":10042,"ecg_description":"Rythme sinusal (ondes P positives en DI, DII, V5, V6, n\u00e9gatives en aVR); espace PR allong\u00e9 (300 ms) et fixe: BAV du premier degr\u00e9; QRS fin sans anomalie;","ecg_info_box":"Le BAV du premier degr\u00e9 correspond \u00e0 un intervalle PR allong\u00e9; on retrouve un nombre \u00e9gal d\u2019ondes P et de complexes QRS et un espace PR d\u00e9passant 200 ms chez l\u2019adulte. Un BAV du premier degr\u00e9 traduit le plus souvent un d\u00e9lai de conduction localis\u00e9 au niveau du noeud auriculo-ventriculaire.","commentary_ecg":"L\u2019intervalle PR correspond au d\u00e9lai entre la d\u00e9polarisation de la premi\u00e8re cellule auriculaire et la d\u00e9polarisation de la premi\u00e8re cellule ventriculaire. L\u2019intervalle PR peut \u00eatre divis\u00e9 entre onde P, dont la largeur est le t\u00e9moin du temps de d\u00e9polarisation des 2 oreillettes, et segment PR, mesur\u00e9 entre la fin de l\u2019onde P et le d\u00e9but de l\u2019onde R, qui traduit le d\u00e9lai de conduction dans le n\u0153ud auriculo-ventriculaire et le r\u00e9seau de His-Purkinje. Le segment PR est le plus souvent iso\u00e9lectrique, les structures travers\u00e9es ne g\u00e9n\u00e9rant pas de signaux d\u2019amplitude suffisante pour \u00eatre d\u00e9tect\u00e9s sur l\u2019\u00e9lectrocardiogramme de surface.\r\n\r\nPour un m\u00eame patient, l\u2019intervalle PR peut ne pas \u00eatre fixe tout au long de la journ\u00e9e et pr\u00e9senter des variations physiologiques (raccourcissement \u00e0 l\u2019effort, allongement dans un contexte vagal). En effet, les vitesses de conduction et les p\u00e9riodes r\u00e9fractaires dans le n\u0153ud auriculo-ventriculaire sont sous la d\u00e9pendance de canaux calciques et varient en fonction de diff\u00e9rents param\u00e8tres (influence du syst\u00e8me nerveux autonome, de certains m\u00e9dicaments et de certaines anomalies m\u00e9taboliques). En d\u00e9pit de ces variations physiologiques, il n\u2019est pas habituel d\u2019indexer et de corriger la valeur de l\u2019espace PR en fonction de la fr\u00e9quence cardiaque (\u00e0 la diff\u00e9rence de l\u2019espace QT). \r\n\r\nLe terme de bloc auriculo-ventriculaire (BAV) du premier degr\u00e9 correspond \u00e0 un allongement de l\u2019intervalle PR au del\u00e0 des valeurs physiologiques. Le terme n\u2019est pas appropri\u00e9 car il ne s\u2019agit pas \u00e0 proprement parler d\u2019un bloc (interruption de la conduction) mais plut\u00f4t d\u2019un ralentissement de la conduction. En effet, on retrouve sur l\u2019\u00e9lectrocardiogramme un nombre \u00e9gal d\u2019ondes P et de complexes QRS (chaque onde P est conduite) et un espace PR d\u00e9passant 200 ms chez l\u2019adulte.\r\n\r\nUn allongement de l\u2019espace PR peut traduire un ralentissement \u00e0 n\u2019importe quel niveau de la \u201cchaine de conduction\u201d entre la premi\u00e8re cellule atriale activ\u00e9e (d\u00e9but de l\u2019onde P) et la premi\u00e8re cellule ventriculaire activ\u00e9e. Un PR long peut survenir \u00e0 la suite : 1) d\u2019un retard de conduction atriale (rare); un allongement majeur du temps de conduction intra-atriale (vitesses de conduction ralenties et\/ou dilatation de l\u2019oreillette) r\u00e9v\u00e9l\u00e9 sur l\u2019\u00e9lectrocardiogramme par une onde P tr\u00e8s large peut entrainer un allongement modeste de l\u2019intervalle PR. 2) d\u2019un retard de conduction dans le n\u0153ud auriculo-ventriculaire (le plus fr\u00e9quent); plus l\u2019intervalle PR est long, plus la probabilit\u00e9 que le ralentissement soit situ\u00e9 dans le n\u0153ud auriculo-ventriculaire est importante. 3) d\u2019un retard dans la conduction distale au niveau du r\u00e9seau de His- Purkinje; le plus souvent associ\u00e9 \u00e0 la pr\u00e9sence d\u2019un QRS large; cela traduit l\u2019existence d\u2019un bloc trifasciculaire et justifie de l\u2019implantation d\u2019un stimulateur cardiaque. \r\n\r\nChez ce patient asymptomatique, l\u2019onde P est normale, le QRS est fin, rendant tr\u00e8s peu probable l\u2019hypoth\u00e8se d\u2019un ralentissement intra-atrial ou d\u2019un ralentissement distal situ\u00e9 dans le r\u00e9seau de His-Purkinje. Un Holter-ECG des 24-heures et une \u00e9preuve d\u2019effort ont montr\u00e9 une r\u00e9duction de l\u2019intervalle PR \u00e0 l\u2019effort, une capacit\u00e9 d\u2019effort conserv\u00e9e et l\u2019absence d\u2019\u00e9pisodes de bloc auriculo-ventriculaire du second ou du troisi\u00e8me degr\u00e9. Cet aspect est probablement b\u00e9nin et ne justifie pas de l\u2019implantation d\u2019un stimulateur.","ecg_info_post_answer":"<img class=\"alignnone wp-image-10284 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-009-1024x709.png\" alt=\"\" width=\"800\" height=\"554\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 1.1: Bloc auriculo-ventriculaire du premier degr\u00e9 - Cardiocases<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-1-1-bloc-auriculo-ventriculaire-du-premier-degre\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 1.1: Bloc auriculo-ventriculaire du premier degr\u00e9 - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-1-1-bloc-auriculo-ventriculaire-du-premier-degre\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-09T07:23:02+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-1-1-ecg-5.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"1459\" \/>\n\t<meta property=\"og:image:height\" content=\"1023\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-1-bloc-auriculo-ventriculaire-du-premier-degre\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-1-bloc-auriculo-ventriculaire-du-premier-degre\/\",\"name\":\"Trac\u00e9 1.1: Bloc auriculo-ventriculaire du premier degr\u00e9 - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-1-bloc-auriculo-ventriculaire-du-premier-degre\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-1-bloc-auriculo-ventriculaire-du-premier-degre\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-1-1-ecg-5.jpeg\",\"datePublished\":\"2026-04-01T07:03:40+00:00\",\"dateModified\":\"2026-04-09T07:23:02+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-1-bloc-auriculo-ventriculaire-du-premier-degre\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-1-1-bloc-auriculo-ventriculaire-du-premier-degre\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-1-bloc-auriculo-ventriculaire-du-premier-degre\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-1-1-ecg-5.jpeg\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-1-1-ecg-5.jpeg\",\"width\":1459,\"height\":1023},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-1-bloc-auriculo-ventriculaire-du-premier-degre\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 1.1: Bloc auriculo-ventriculaire du premier degr\u00e9\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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