{"id":10071,"date":"2026-04-01T11:23:49","date_gmt":"2026-04-01T11:23:49","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10071"},"modified":"2026-04-01T11:23:50","modified_gmt":"2026-04-01T11:23:50","slug":"trace-2-2-dysfonction-sinusale-echappement-jonctionnel","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-2-dysfonction-sinusale-echappement-jonctionnel\/","title":{"rendered":"Trac\u00e9 2.2: Dysfonction sinusale, \u00e9chappement jonctionnel"},"content":{"rendered":"","protected":false},"featured_media":10070,"template":"","ecg_case_type":[251],"language_ecgcase":[259],"class_list":["post-10071","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-sinus-dysfunction","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 2.2: Dysfonction sinusale, \u00e9chappement jonctionnel","patient_description":"Femme de 73 ans, hypertendue avec hypertrophie ventriculaire gauche concentrique; \u00e9lec\u00ad trocardiogramme de surface de contr\u00f4le; patiente asth\u00e9nique","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 \u00e9chappement jonctionnel","quiz_answer_5":"il existe un BAV du troisi\u00e8me degr\u00e9","correct_answer":["B","C","D"],"ecg_image":10070,"ecg_description":"jonctionnel (QRS fins, r\u00e9guliers et mod\u00e9r\u00e9ment ralentis), conduction r\u00e9trograde (activit\u00e9 atriale n\u00e9gative dans les d\u00e9rivations inf\u00e9rieures avec intervalle RP\u2019 fixe), hypertrophie ventriculaire gauche (indice de Sokolow \u00e0 38) avec troubles de la repolarisation asp\u00e9cifiques","ecg_info_box":"Bradycardie mod\u00e9r\u00e9e, fr\u00e9quence cardiaque \u00e0 57 battements\/minute, dysfonction sinusale avec absence totale d\u2019onde P sinusale, \u00e9chappement jonctionnel (QRS fins, r\u00e9guliers et mod\u00e9r\u00e9ment ralentis), conduction r\u00e9trograde (activit\u00e9 atriale n\u00e9gative dans les d\u00e9rivations inf\u00e9rieures avec intervalle RP\u2019 fixe), hypertrophie ventriculaire gauche (indice de Sokolow \u00e0 38) avec troubles de la repolarisation asp\u00e9cifiques;","commentary_ecg":"En l\u2019absence totale d\u2019activit\u00e9 sinusale, un foyer jonctionnel prend le plus souvent le relai avec un aspect typique de complexe QRS peu ou pas modifi\u00e9 et une conduction atriale r\u00e9trograde. Une fr\u00e9quence sinusale dite normale correspond par d\u00e9finition \u00e0 une fr\u00e9quence au repos situ\u00e9e entre 50-60 et 100 battements\/minute. Il est toutefois fr\u00e9quent et sans caract\u00e8re pathologique d\u2019observer le jour ou plus souvent la nuit, un ralentissement de la fr\u00e9quence cardiaque, chez le patient sportif ou vagotonique (activit\u00e9 sinusale descendant parfois en dessous de 40 battements\/minute). Il est commun de d\u00e9finir une bradycardie sinusale (avec ou sans \u00e9chappement) comme pathologique quand elle engendre la survenue de sympt\u00f4mes.\r\n\r\nLe trac\u00e9 observ\u00e9 chez cette patiente correspond \u00e0 une absence totale d\u2019expression de l\u2019activit\u00e9 sinusale avec \u00e9chappement jonctionnel et conduction atriale r\u00e9trograde. Les m\u00e9canismes impliqu\u00e9s peuvent soit \u00eatre une absence d\u2019influx sinusal ou un bloc de sortie de l\u2019influx sinusal au niveau du myocarde auriculaire (bloc sino-auriculaire du troisi\u00e8me degr\u00e9). En l\u2019absence d\u2019activit\u00e9 sinusale, la d\u00e9polarisation ventriculaire peut \u00eatre initi\u00e9e par un centre d\u2019automatisme secondaire qui g\u00e9n\u00e8re l\u2019influx par d\u00e9polarisation spontan\u00e9e en phase IV. Lors d\u2019un \u00e9pisode de dysfonction sinusale, le foyer ectopique d\u2019\u00e9chappement est le plus souvent jonctionnel et se situe au niveau de la partie basse du n\u0153ud d\u2019Ashoff-Tawara ou de la portion adjacente du tronc commun du faisceau de His dite r\u00e9gion nodo-hisienne. Si aucun foyer jonctionnel n\u2019apparait, un foyer ventriculaire (plus bas situ\u00e9, QRS large) ou occasionnellement un autre foyer atrial lent (le plus souvent un foyer du sinus coronaire, acticit\u00e9 atriale n\u00e9gative dans les d\u00e9rivations inf\u00e9rieures) peuvent faire office de pacemaker subsidiaire. Quand l\u2019\u00e9chappement est jonctionnel, l\u2019aspect du complexe QRS n\u2019est habituellement pas modifi\u00e9 par rapport \u00e0 celui observ\u00e9 lorsque le rythme est sinusal. Dans de rares cas, on peut observer un aspect l\u00e9g\u00e8rement modifi\u00e9, l\u2019explication pour ces diff\u00e9rences de morphologie toujours discr\u00e8tes n\u2019\u00e9tant pas compl\u00e8tement \u00e9tablie.","ecg_info_post_answer":"\"\""},"yoast_head":"\nTrac\u00e9 2.2: Dysfonction sinusale, \u00e9chappement jonctionnel - 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-2-2-dysfonction-sinusale-echappement-jonctionnel\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 2.2: Dysfonction sinusale, \u00e9chappement jonctionnel - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-2-dysfonction-sinusale-echappement-jonctionnel\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-01T11:23:50+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-2-2-dysfonction-sinusale-echappement-jonctionnel\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-2-2-dysfonction-sinusale-echappement-jonctionnel\/\",\"name\":\"Trac\u00e9 2.2: Dysfonction sinusale, \u00e9chappement jonctionnel - 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