{"id":10045,"date":"2026-04-01T07:09:39","date_gmt":"2026-04-01T07:09:39","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10045"},"modified":"2026-04-09T07:24:08","modified_gmt":"2026-04-09T07:24:08","slug":"trace-1-2-bloc-auriculo-ventriculaire-du-premier-degre-et-pr-tres-long","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-1-2-bloc-auriculo-ventriculaire-du-premier-degre-et-pr-tres-long\/","title":{"rendered":"Trac\u00e9 1.2: Bloc auriculo-ventriculaire du premier degr\u00e9 et pr tr\u00e8s long"},"content":{"rendered":"","protected":false},"featured_media":10044,"template":"","ecg_case_type":[250],"language_ecgcase":[259],"class_list":["post-10045","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 1.2: Bloc auriculo-ventriculaire du premier degr\u00e9 et pr tr\u00e8s long","patient_description":"Homme de 68 ans, dyspn\u00e9e d\u2019effort stade IIB (efforts mod\u00e9r\u00e9s)","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":"il existe une activit\u00e9 atriale r\u00e9trograde","quiz_answer_4":"il existe un BAV du premier degr\u00e9","quiz_answer_5":"il existe un QT long","correct_answer":["A","D"],"ecg_image":10044,"ecg_description":"Rythme sinusal (ondes P positives en DI, DII, V5, V6, n\u00e9gatives en aVR); espace PR tr\u00e8s allong\u00e9 (520 ms) et fixe: BAV du premier degr\u00e9; QRS fins sans anomalie","ecg_info_box":"L\u2019existence d\u2019un PR long \u00e0 l\u2019effort peut favoriser la survenue de sympt\u00f4mes en raison de la survenue d\u2019une contraction des oreillettes sur valves mitrales ferm\u00e9es.","commentary_ecg":"Un allongement important de l\u2019espace PR sur un rythme cardiaque relativement rapide peut entrainer une superposition de l\u2019onde P et de l\u2019onde T qui pr\u00e9c\u00e8de ce qui rend l\u2019interpr\u00e9tation difficile avec un risque de confusion avec un rythme jonctionnel. Des variations de la fr\u00e9quence cardiaque permettent en g\u00e9n\u00e9ral de rectifier le diagnostic en aidant \u00e0 la visualisation des ondes P. G\u00e9n\u00e9ralement l\u2019allongement ne d\u00e9passe pas 400 ms m\u00eame si on a pu observer des valeurs d\u2019espace PR d\u00e9passant 800 ms. Il peut arriver dans ces cas extr\u00eames que la dur\u00e9e du PR d\u00e9passe celle du PP et que l\u2019onde P responsable du complexe QRS ne soit pas celle qui le pr\u00e9c\u00e8de sur le trac\u00e9. Le si\u00e8ge du ralentissement est le plus souvent nodal (surtout quand le QRS est fin) et donc de plut\u00f4t bon pronostic. Une exploration \u00e9lectrophysiologique met en \u00e9vidence un intervalle AH allong\u00e9 t\u00e9moin du retard de conduction dans le n\u0153ud auriculo-ventriculaire.\r\n\r\nL\u2019existence d\u2019un PR tr\u00e8s long peut \u00eatre associ\u00e9e avec la survenue de sympt\u00f4mes, si la r\u00e9ponse \u00e0 l\u2019effort n\u2019est pas physiologique. En effet, comme chez ce patient, une \u00e9preuve d\u2019effort peut documenter une absence de r\u00e9duction de l\u2019espace PR en parall\u00e8le \u00e0 l\u2019augmentation de fr\u00e9quence. Si les espaces RR se raccourcissent et que l\u2019intervalle PR reste fixe et tr\u00e8s allong\u00e9, la systole atriale suivant la d\u00e9polarisation survient trop t\u00f4t dans la diastole ou peut m\u00eame survenir en fin de systole ventriculaire entrainant une perte de la contribution atriale active \u00e0 l\u2019\u00e9jection cardiaque, un raccourcissement du temps de remplissage ventriculaire gauche, une fuite mitrale diastolique et dans les cas les plus marqu\u00e9s une contraction atriale sur valves mitrales ferm\u00e9es. Cela peut s\u2019accompagner d\u2019une symptomatologie plus ou moins marqu\u00e9e (dyspn\u00e9e d\u2019effort, sensation de flux r\u00e9trograde dans les veines jugulaires, palpitations, malaise) proche de celle observ\u00e9e chez les patients stimul\u00e9s en mode VVI avec conduction r\u00e9trograde (syndrome du pacemaker). Un certain nombre d\u2019\u00e9tudes non contr\u00f4l\u00e9es sugg\u00e8rent que l\u2019implantation d\u2019un stimulateur cardiaque permet de r\u00e9duire les sympt\u00f4mes et d\u2019am\u00e9liorer le statut fonctionnel.\r\n\r\nIl existe dans les derni\u00e8res recommandations europ\u00e9ennes (classe IIA), une indication h\u00e9modynamique \u00e0 la pose d\u2019un stimulateur cardiaque pour ce type de pr\u00e9sentation: \u201cl\u2019implantation d\u2019un stimulateur devrait \u00eatre consid\u00e9r\u00e9 chez les patients pr\u00e9sentant un BAV du premier degr\u00e9 (PR > 300 ms) et des sympt\u00f4mes compatibles avec un syndrome du pacemaker.\u201d \r\n\r\nCe patient, ne pr\u00e9sentait aucune symptomatologie type malaise, lipothymie ou syncope, mais a quand m\u00eame \u00e9t\u00e9 implant\u00e9 d\u2019un stimulateur cardiaque qui a permis de r\u00e9duire les sympt\u00f4mes d\u2019effort en \u201cresynchronisant\u201d activit\u00e9 atriale et activit\u00e9 ventriculaire au repos et \u00e0 l\u2019effort.","ecg_info_post_answer":"<img class=\"alignnone wp-image-10285 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-013-1024x586.png\" alt=\"\" width=\"800\" height=\"458\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - 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