{"id":10073,"date":"2026-04-01T11:22:32","date_gmt":"2026-04-01T11:22:32","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10073"},"modified":"2026-04-01T11:22:33","modified_gmt":"2026-04-01T11:22:33","slug":"trace-2-3-dysfonction-sinusale-echappement-jonctionnel-dyspnee-deffort","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-3-dysfonction-sinusale-echappement-jonctionnel-dyspnee-deffort\/","title":{"rendered":"Trac\u00e9 2.3: Dysfonction sinusale, \u00e9chappement jonctionnel, dyspn\u00e9e d\u2019effort"},"content":{"rendered":"","protected":false},"featured_media":10072,"template":"","ecg_case_type":[251],"language_ecgcase":[259],"class_list":["post-10073","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 2.3: Dysfonction sinusale, \u00e9chappement jonctionnel, dyspn\u00e9e d\u2019effort","patient_description":"Homme de 64 ans, cardiopathie dilat\u00e9e, hospitalis\u00e9 pour asth\u00e9nie et limitation \u00e0 l\u2019effort","quiz_question":"Concernant cet ECG, quelle(s) est(sont) la(les) r\u00e9ponse(s) vraie(s)?","quiz_answer_1":"FA","quiz_answer_2":"dysfonction sinusale","quiz_answer_3":"l\u2019activit\u00e9 atriale est r\u00e9trograde","quiz_answer_4":"\u00e9chappement jonctionnel","quiz_answer_5":"BAV du troisi\u00e8me degr\u00e9","correct_answer":["B","C","D"],"ecg_image":10072,"ecg_description":"Bradycardie avec fr\u00e9quence \u00e0 45 battements\/minute, dysfonction sinusale avec absence totale d\u2019onde P sinusale, \u00e9chappement probablement jonctionnel (QRS r\u00e9guliers et mod\u00e9r\u00e9ment ralentis), avec aspect de bloc de branche droit; conduction r\u00e9trograde (activit\u00e9 atriale n\u00e9gative dans les d\u00e9rivations inf\u00e9rieures avec intervalle RP\u2019 fixe);","ecg_info_box":"L\u2019insuffisance chronotrope correspond \u00e0 une forme particuli\u00e8re de dysfonction sinusale avec apparition ou majoration de sympt\u00f4mes en rapport avec une acc\u00e9l\u00e9ration insuffisante de la fr\u00e9quence cardiaque. L\u2019implantation d\u2019un stimulateur cardiaque asservi (possibilit\u00e9 d\u2019acc\u00e9l\u00e9ration de la fr\u00e9quence de stimulation \u00e0 l\u2019effort) en constitue le traitement de r\u00e9f\u00e9rence. ","commentary_ecg":"Ce patient \u00e9tait symptomatique avec existence d\u2019une asth\u00e9nie et d\u2019une dyspn\u00e9e d\u2019effort. L\u2019\u00e9preuve d\u2019effort a permis de mettre en \u00e9vidence une insuffisance chronotrope majeure avec dyspn\u00e9e apparaissant d\u00e8s les premiers paliers en rapport avec une absence quasi-totale d\u2019acc\u00e9l\u00e9ration de la fr\u00e9quence cardiaque et la persistance d\u2019un \u00e9chappement jonctionnel sans r\u00e9apparition de l\u2019activit\u00e9 sinusale normale. L\u2019existence de cette incomp\u00e9tence chronotrope sans cause curable a conduit \u00e0 la d\u00e9cision d\u2019implantation d\u2019un stimulateur cardiaque (indication classe I). Il existe effectivement un consensus sur le fait que l\u2019implantation d\u2019un stimulateur cardiaque ne modifie pas la survie des patients avec dysfonction sinusale mais permet de r\u00e9duire les sympt\u00f4mes associ\u00e9s. Il n\u2019y a donc pas en th\u00e9orie d\u2019indication chez les patients asymptomatiques (classe III).\r\n","ecg_info_post_answer":"\"\""},"yoast_head":"\nTrac\u00e9 2.3: Dysfonction sinusale, \u00e9chappement jonctionnel, dyspn\u00e9e d\u2019effort - 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-2-3-dysfonction-sinusale-echappement-jonctionnel-dyspnee-deffort\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 2.3: Dysfonction sinusale, \u00e9chappement jonctionnel, dyspn\u00e9e d\u2019effort - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-3-dysfonction-sinusale-echappement-jonctionnel-dyspnee-deffort\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-01T11:22:33+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-2-3-dysfonction-sinusale-echappement-jonctionnel-dyspnee-deffort\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-2-3-dysfonction-sinusale-echappement-jonctionnel-dyspnee-deffort\/\",\"name\":\"Trac\u00e9 2.3: Dysfonction sinusale, \u00e9chappement jonctionnel, dyspn\u00e9e d\u2019effort - 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