{"id":10053,"date":"2026-04-01T08:08:08","date_gmt":"2026-04-01T08:08:08","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10053"},"modified":"2026-04-09T07:30:05","modified_gmt":"2026-04-09T07:30:05","slug":"trace-1-6-syncope-bloc-de-branche-gauche-et-bloc-auriculo-ventriculaire-du-second-degre-type-1","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-1-6-syncope-bloc-de-branche-gauche-et-bloc-auriculo-ventriculaire-du-second-degre-type-1\/","title":{"rendered":"Trac\u00e9 1.6: Syncope, bloc de branche gauche et bloc auriculo-ventriculaire du second degr\u00e9 type 1"},"content":{"rendered":"","protected":false},"featured_media":10052,"template":"","ecg_case_type":[250],"language_ecgcase":[259],"class_list":["post-10053","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 1.6: Syncope, bloc de branche gauche et bloc auriculo-ventriculaire du second degr\u00e9 type 1","patient_description":"Femme de 87 ans; hospitalisation \u00e0 la suite de 2 syncopes \u00e0 l\u2019emporte pi\u00e8ce","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) vrai(s) pour cet ECG?","quiz_answer_1":"rythme sinusal","quiz_answer_2":"hypertrophie auriculaire gauche","quiz_answer_3":"bloc de branche droit + h\u00e9mibloc ant\u00e9rieur gauche","quiz_answer_4":"bloc de branche gauche","quiz_answer_5":"bloc indiff\u00e9renci\u00e9","correct_answer":["A","B","D"],"ecg_image":10637,"ecg_description":"Rythme sinusal, hypertrophie auriculaire gauche (onde P \u00e9largie et fragment\u00e9e); bloc de branche gauche: largeur du QRS > 120 ms; absence d\u2019onde q et onde R large et crochet\u00e9e en DI, aVL, V5 et V6 avec retard de la d\u00e9flexion intrins\u00e9co\u00efde > 60 ms; aspect QS et rS en V1 et V2; sous-d\u00e9calage segment ST et onde T n\u00e9gative en DI, aVL, V5 et V6; ","ecg_info_box":"Lorsqu\u2019il existe un bloc de branche associ\u00e9, un aspect de BAV du second degr\u00e9 type Luciani-Wenckebach peut r\u00e9sulter d\u2019un ralentissement dans le noeud auriculo-ventriculaire mais doit faire suspecter et redouter un ralentissement de l\u2019activation sur la branche oppos\u00e9e \u00e0 la branche bloqu\u00e9e (bloc trifasciculaire).","commentary_ecg":"-","ecg_info_post_answer":"&nbsp;\r\n\r\n&nbsp;\r\n\r\nAu cours d\u2019un \u00e9pisode de lipothymie...\r\n\r\n<img class=\"alignnone wp-image-10398 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-1-6-ecg2-1024x714.png\" alt=\"\" width=\"800\" height=\"558\" \/>\r\n\r\n<strong>Trac\u00e9<\/strong>\r\n\r\nBloc de branche gauche; bradycardie en rapport avec un aspect de BAV du second degr\u00e9 type Mobitz 1; allongement progressif de l\u2019intervalle PR puis onde P bloqu\u00e9e (p\u00e9riodes de Luciani Wenckebach);\r\n\r\n&nbsp;\r\n\r\n<strong>Commentaire<\/strong>\r\n\r\nCette patiente avait donc pr\u00e9sent\u00e9 une syncope brutale avec chute et plaie du cuir chevelu. L\u2019\u00e9lectrocardiogramme retrouvait un aspect caract\u00e9ristique de bloc de branche gauche complet. Au cours d\u2019un \u00e9pisode de lipothymie, l\u2019ECG montre une bradycardie en rapport avec un aspect de BAV du second degr\u00e9 (Mobitz 1).\r\n\r\nLorsqu\u2019il existe un bloc de branche associ\u00e9, un aspect de BAV du second degr\u00e9 type Luciani-Wenckebach peut r\u00e9sulter d\u2019un ralentissement dans le n\u0153ud auriculo- ventriculaire mais doit faire suspecter et redouter un ralentissement de l\u2019activation sur la branche oppos\u00e9e \u00e0 la branche bloqu\u00e9e (bloc trifasciculaire). Les p\u00e9riodes de Luciani-Wenckebach infra-hisiennes sont alors associ\u00e9es avec un espace AH constant et un allongement progressif de l\u2019intervalle HV, l\u2019onde P bloqu\u00e9e \u00e9tant suivie d\u2019un potentiel hisien non conduit au ventricule.\r\n\r\nLes indications d\u2019implantation dans le cadre du BAV du second degr\u00e9 type 1 sont controvers\u00e9es. La relation de causalit\u00e9 entre le trouble de conduction et la survenue de sympt\u00f4mes est difficile \u00e0 \u00e9tablir, particuli\u00e8rement quand les sympt\u00f4mes sont modestes et peu sp\u00e9cifiques. Il existe dans les recommandations europ\u00e9ennes, une indication classe IIA quand un BAV du second degr\u00e9 type 1 est responsable de sympt\u00f4mes ou que la localisation du trouble de conduction est intra- ou infra- hisienne (risque majeur d\u2019\u00e9volution vers un bloc auriculo-ventriculaire complet) lors d\u2019une exploration \u00e9lectrophysiologique. Cette patiente a b\u00e9n\u00e9fici\u00e9 d\u2019une exploration qui a confirm\u00e9 l\u2019existence d\u2019un bloc trifasciculaire et a b\u00e9n\u00e9fici\u00e9 de l\u2019implantation d\u2019un stimulateur cardiaque.\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10289 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-033-1024x659.png\" alt=\"\" width=\"800\" height=\"515\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 1.6: Syncope, bloc de branche gauche et bloc auriculo-ventriculaire du second degr\u00e9 type 1 - 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-1-6-syncope-bloc-de-branche-gauche-et-bloc-auriculo-ventriculaire-du-second-degre-type-1\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 1.6: Syncope, bloc de branche gauche et bloc auriculo-ventriculaire du second degr\u00e9 type 1 - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-1-6-syncope-bloc-de-branche-gauche-et-bloc-auriculo-ventriculaire-du-second-degre-type-1\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-09T07:30:05+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-1-6-ecg-4.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"1756\" \/>\n\t<meta property=\"og:image:height\" content=\"1112\" \/>\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-1-6-syncope-bloc-de-branche-gauche-et-bloc-auriculo-ventriculaire-du-second-degre-type-1\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-6-syncope-bloc-de-branche-gauche-et-bloc-auriculo-ventriculaire-du-second-degre-type-1\/\",\"name\":\"Trac\u00e9 1.6: Syncope, bloc de branche gauche et bloc auriculo-ventriculaire du second degr\u00e9 type 1 - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-6-syncope-bloc-de-branche-gauche-et-bloc-auriculo-ventriculaire-du-second-degre-type-1\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-6-syncope-bloc-de-branche-gauche-et-bloc-auriculo-ventriculaire-du-second-degre-type-1\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-1-6-ecg-4.jpeg\",\"datePublished\":\"2026-04-01T08:08:08+00:00\",\"dateModified\":\"2026-04-09T07:30:05+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-6-syncope-bloc-de-branche-gauche-et-bloc-auriculo-ventriculaire-du-second-degre-type-1\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-1-6-syncope-bloc-de-branche-gauche-et-bloc-auriculo-ventriculaire-du-second-degre-type-1\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-6-syncope-bloc-de-branche-gauche-et-bloc-auriculo-ventriculaire-du-second-degre-type-1\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-1-6-ecg-4.jpeg\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-1-6-ecg-4.jpeg\",\"width\":1756,\"height\":1112},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-1-6-syncope-bloc-de-branche-gauche-et-bloc-auriculo-ventriculaire-du-second-degre-type-1\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 1.6: Syncope, bloc de branche gauche et bloc auriculo-ventriculaire du second degr\u00e9 type 1\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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