{"id":10049,"date":"2026-04-01T07:21:46","date_gmt":"2026-04-01T07:21:46","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10049"},"modified":"2026-04-01T07:21:47","modified_gmt":"2026-04-01T07:21:47","slug":"trace-1-4-bloc-auriculo-ventriculaire-du-second-degre-type-luciani-wenckebach","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-1-4-bloc-auriculo-ventriculaire-du-second-degre-type-luciani-wenckebach\/","title":{"rendered":"Trac\u00e9 1.4: Bloc auriculo-ventriculaire du second degr\u00e9 type luciani-wenckebach"},"content":{"rendered":"","protected":false},"featured_media":10048,"template":"","ecg_case_type":[250],"language_ecgcase":[259],"class_list":["post-10049","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 1.4: Bloc auriculo-ventriculaire du second degr\u00e9 type luciani-wenckebach","patient_description":"Homme de 57 ans, ancien sportif de haut niveau, asymptomatique; \u00e9lectrocardiogramme de routine","quiz_question":"Concernant cet ECG, quelle(s) est(sont) la(les) r\u00e9ponse(s) vraie(s)?","quiz_answer_1":"l\u2019ECG montre un BAV du premier degr\u00e9","quiz_answer_2":"l\u2019ECG montre un BAV du second degr\u00e9 type Luciani-Wenckebach","quiz_answer_3":"l\u2019ECG montre un BAV du second degr\u00e9 type Mobitz 1","quiz_answer_4":"l\u2019ECG montre un BAV du second degr\u00e9 type Mobitz 2","quiz_answer_5":"l\u2019ECG montre une dysfonction sinusale","correct_answer":["B","C"],"ecg_image":10048,"ecg_description":"Activit\u00e9 atriale sinusale (ondes P positives en DI, DII, V5, V6, n\u00e9gatives en aVR); hypertrophie auriculaire gauche (dur\u00e9e augment\u00e9e de l\u2019onde P, aspect bifide en DII, n\u00e9gativit\u00e9 importante en V1), aspect de BAV du second degr\u00e9 type Mobitz 1 avec des p\u00e9riodes de Luciani-Wenckebach: allongement de l\u2019espace PR puis onde P bloqu\u00e9e (3 ondes P conduites, une onde P bloqu\u00e9e, puis 5 ondes P conduites, une onde P bloqu\u00e9e);","ecg_info_box":"Le BAV du second degr\u00e9 type Luciani-Wenckebach correspond \u00e0 un allongement progressif de l\u2019espace PR jusqu\u2019\u00e0 la survenue d\u2019une onde P bloqu\u00e9e, avec r\u00e9p\u00e9tition de ce type de s\u00e9quence.","commentary_ecg":"Le BAV du second degr\u00e9 type 1 (Mobitz 1) est d\u00e9fini par la pr\u00e9sence intermittente d\u2019une onde P bloqu\u00e9e avec un intervalle PR variable. Le BAV du second degr\u00e9 type Luciani- Wenckebach est une forme particuli\u00e8re de BAV du second degr\u00e9 type 1; on observe dans ce cadre un allongement progressif de l\u2019espace PR jusqu\u2019\u00e0 la survenue d\u2019une onde P bloqu\u00e9e; apr\u00e8s la pause, l\u2019onde P suivante est conduite avec un intervalle PR revenant \u00e0 la valeur de base puis la m\u00eame s\u00e9quence se reproduit (p\u00e9riodes de Luciani-Wenckebach). Ces p\u00e9riodes peuvent \u00eatre plus ou moins longues, comportant entre 2 et 10 ondes P conduites pour une onde P bloqu\u00e9e. L\u2019incr\u00e9ment de l\u2019espace PR est souvent plus important au d\u00e9but du cycle Wenckebach et a tendance \u00e0 diminuer de cycle \u00e0 cycle. L\u2019intervalle PR peut par exemple \u00eatre mesur\u00e9 \u00e0 150 ms sur le premier cycle puis s\u2019allonger \u00e0 250 ms sur le second (+100 ms), \u00e0 300 ms sur le suivant (+ 50 ms), et finalement \u00e0 330 ms (+ 30 ms) avant que l\u2019onde P ne soit bloqu\u00e9e. Les cycles PP \u00e9tant stables, un raccourcissement des intervalles RR est alors observ\u00e9 avant la survenue de la pause.\r\n\r\nLa conduction au niveau du n\u0153ud atrio-ventriculaire est dite d\u00e9cr\u00e9mentielle avec une modification des vitesses de conduction en fonction de la fr\u00e9quence des influx (implication des canaux calciques), ce qui n\u2019est pas le cas pour le r\u00e9seau distal de His-Purkinje (implication des canaux potassiques) o\u00f9 la conduction est de type tout ou rien.\r\n\r\nQuand la fr\u00e9quence cardiaque augmente, en l\u2019absence de stimulation adr\u00e9nergique concomitante (exemple d\u2019une stimulation atriale \u00e0 fr\u00e9quence croissante), les vitesses de conduction nodale s\u2019allongent entrainant une augmentation progressive de l\u2019espace PR. En revanche, si l\u2019augmentation de la fr\u00e9quence survient en rapport avec un effort ou un stress, la conduction d\u00e9cr\u00e9mentielle est compens\u00e9e par le raccourcissement des p\u00e9riodes r\u00e9fractaires induit par les cat\u00e9cholamines (r\u00e9sultant en un PR non modifi\u00e9 ou raccourci). Quand le PR s\u2019allonge avec une fr\u00e9quence atriale constante (comme sur ce trac\u00e9), l\u2019onde P se rapproche progressivement du QRS pr\u00e9c\u00e9dent, l\u2019intervalle RP devient de plus en plus court, entrainant en raison de cette conduction d\u00e9cr\u00e9mentielle un allongement de l\u2019intervalle PR qui entretient le ph\u00e9nom\u00e8ne et conduit \u00e0 la survenue d\u2019une onde P bloqu\u00e9e.\r\n\r\nLe BAV du second degr\u00e9 type 1 correspond tr\u00e8s majoritairement \u00e0 un trouble de la conduction situ\u00e9 au niveau du n\u0153ud atrio-ventriculaire et \u00e0 une exag\u00e9ration de la conduction d\u00e9cr\u00e9mentielle. Ce si\u00e8ge explique la morphologie le plus souvent normale des complexes QRS. Lors d\u2019une exploration \u00e9lectrophysiologique, un ralentissement nodal se traduit par un allongement progressif de l\u2019espace AH, l\u2019intervalle HV \u00e9tant normal et l\u2019onde P bloqu\u00e9e n\u2019\u00e9tant pas suivie d\u2019un potentiel hisien.\r\n\r\nChez ce patient asymptomatique, ancien sportif, une \u00e9preuve d\u2019effort a montr\u00e9 une reprise d\u2019un synchronisme atrio-ventriculaire normal (absence d\u2019ondes P bloqu\u00e9es, PR allong\u00e9 puis se raccourcissant \u00e0 l\u2019effort). Les complexes QRS fins sont \u00e9vocateurs d\u2019un trouble intra-nodal avec un risque faible d\u2019\u00e9volution vers le bloc auriculo- ventriculaire du troisi\u00e8me degr\u00e9. Ce patient est rest\u00e9 asymptomatique en l\u2019absence d\u2019implantation d\u2019un stimulateur.","ecg_info_post_answer":"<img class=\"alignnone wp-image-10287 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-021-1024x493.png\" alt=\"\" width=\"800\" height=\"385\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 1.4: Bloc auriculo-ventriculaire du second degr\u00e9 type luciani-wenckebach - 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-1-4-bloc-auriculo-ventriculaire-du-second-degre-type-luciani-wenckebach\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 1.4: Bloc auriculo-ventriculaire du second degr\u00e9 type luciani-wenckebach - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-1-4-bloc-auriculo-ventriculaire-du-second-degre-type-luciani-wenckebach\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-01T07:21:47+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-4-bloc-auriculo-ventriculaire-du-second-degre-type-luciani-wenckebach\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-4-bloc-auriculo-ventriculaire-du-second-degre-type-luciani-wenckebach\/\",\"name\":\"Trac\u00e9 1.4: Bloc auriculo-ventriculaire du second degr\u00e9 type luciani-wenckebach - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-4-bloc-auriculo-ventriculaire-du-second-degre-type-luciani-wenckebach\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-4-bloc-auriculo-ventriculaire-du-second-degre-type-luciani-wenckebach\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-1-4-ecg-4-scaled.png\",\"datePublished\":\"2026-04-01T07:21:46+00:00\",\"dateModified\":\"2026-04-01T07:21:47+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-4-bloc-auriculo-ventriculaire-du-second-degre-type-luciani-wenckebach\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-1-4-bloc-auriculo-ventriculaire-du-second-degre-type-luciani-wenckebach\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-4-bloc-auriculo-ventriculaire-du-second-degre-type-luciani-wenckebach\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-1-4-ecg-4-scaled.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-1-4-ecg-4-scaled.png\",\"width\":2560,\"height\":1784},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-4-bloc-auriculo-ventriculaire-du-second-degre-type-luciani-wenckebach\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 1.4: Bloc auriculo-ventriculaire du second degr\u00e9 type luciani-wenckebach\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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