{"id":10065,"date":"2026-04-01T11:13:29","date_gmt":"2026-04-01T11:13:29","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10065"},"modified":"2026-04-01T11:13:31","modified_gmt":"2026-04-01T11:13:31","slug":"trace-1-11-fibrillation-atriale-et-trouble-de-conduction-atrioventriculaire","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-1-11-fibrillation-atriale-et-trouble-de-conduction-atrioventriculaire\/","title":{"rendered":"Trac\u00e9 1.11: Fibrillation atriale et trouble de conduction atrioventriculaire"},"content":{"rendered":"","protected":false},"featured_media":10064,"template":"","ecg_case_type":[250],"language_ecgcase":[259],"class_list":["post-10065","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 1.11: Fibrillation atriale et trouble de conduction atrioventriculaire","patient_description":"Homme de 83 ans; hospitalisation pour syncope","quiz_question":"Concernant cet ECG, quelle(s) est(sont) la(les) r\u00e9ponse(s) vraie(s)?","quiz_answer_1":"l\u2019ECG montre un aspect de rythme sinusal","quiz_answer_2":"l\u2019ECG montre un aspect de flutter atrial","quiz_answer_3":"l\u2019ECG montre un aspect de FA","quiz_answer_4":"l\u2019ECG montre un aspect de FA lente conduite","quiz_answer_5":"l\u2019ECG montre un battement avec \u00e9chappement jonctionnel","correct_answer":["C","D","E"],"ecg_image":10064,"ecg_description":"FA: activit\u00e9 atriale tr\u00e8s rapide, polymorphe, anarchique avec tr\u00e9mulation de la ligne de base; FA lente correspondant \u00e0 une FA conduite (ventricules fins irr\u00e9guliers) mais avec une conduction atrio-ventriculaire alt\u00e9r\u00e9e (ventricules tr\u00e8s lents); le troisi\u00e8me complexe correspond probablement \u00e0 un \u00e9chappement jonctionnel (QRS fin avec un aspect l\u00e9g\u00e8rement diff\u00e9rent par rapport aux QRS conduits);","ecg_info_box":"Le diagnostic de fibrillation auriculaire doit \u00eatre port\u00e9 sur la mise en \u00e9vidence d\u2019une activit\u00e9 atriale, irr\u00e9guli\u00e8re, anarchique et tr\u00e8s rapide. L\u2019existence d\u2019une fr\u00e9quence ventriculaire rapide et irr\u00e9guli\u00e8re est fr\u00e9quente mais n\u2019est pas un pr\u00e9requis au diagnostic. En effet, comme chez ce patient, la fr\u00e9quence ventriculaire peut \u00eatre lente et plus ou moins r\u00e9guli\u00e8re en pr\u00e9sence d\u2019un trouble de conduction auriculo-ventriculaire.","commentary_ecg":"Ce patient pr\u00e9sente donc une FA lente. Lors d\u2019un \u00e9pisode de FA en pr\u00e9sence d\u2019une conduction atrio-ventriculaire pr\u00e9serv\u00e9e, le rythme ventriculaire est irr\u00e9gulier, rapide et sup\u00e9rieur \u00e0 100 bpm m\u00eame si il reste bien inf\u00e9rieur \u00e0 celui des oreillettes. Il existe en effet un \u201cbloc\u201d fonctionnel au niveau de la jonction en raison de la dur\u00e9e de la p\u00e9riode r\u00e9fractaire du n\u0153ud auriculo-ventriculaire. Il existe toutefois certaines particularit\u00e9s \u00e0 connaitre. La fr\u00e9quence ventriculaire peut \u00eatre tr\u00e8s ralentie comme chez ce patient avec un rythme pouvant \u00eatre inf\u00e9rieur \u00e0 40 bpm. Une bradycardie ventriculaire r\u00e9guli\u00e8re sugg\u00e8re l\u2019existence d\u2019un BAV complet avec interruption totale de la conduction et \u00e9chappement le plus souvent jonctionnel. Un rythme ventriculaire restant irr\u00e9gulier est plut\u00f4t en faveur d\u2019une conduction tr\u00e8s alt\u00e9r\u00e9e mais toujours pr\u00e9sente.\r\n\r\nDans les 2 cas, quand le patient est symptomatique sur une fr\u00e9quence ventriculaire tr\u00e8s lente, l\u2019indication d\u2019implantation d\u2019un stimulateur cardiaque est indiscutable. 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