{"id":10075,"date":"2026-04-01T11:25:46","date_gmt":"2026-04-01T11:25:46","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10075"},"modified":"2026-04-01T11:25:47","modified_gmt":"2026-04-01T11:25:47","slug":"trace-2-4-bloc-sino-auriculaire","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-4-bloc-sino-auriculaire\/","title":{"rendered":"Trac\u00e9 2.4: Bloc sino-auriculaire"},"content":{"rendered":"","protected":false},"featured_media":10074,"template":"","ecg_case_type":[251],"language_ecgcase":[259],"class_list":["post-10075","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 2.4: Bloc sino-auriculaire","patient_description":"Femme de 45 ans sans ant\u00e9c\u00e9dent, asymptomatique, mise en \u00e9vidence d\u2019une bradycardie \u00e0 l\u2019auscultation; enregistrement d\u2019un Holter-ECG des 24 heures","quiz_question":"Concernant cet ECG, quelle(s) est(sont) la(les) r\u00e9ponse(s) vraie(s)?","quiz_answer_1":"l\u2019activit\u00e9 atriale est sinusale","quiz_answer_2":"il existe une dysfonction sinusale","quiz_answer_3":"il existe un BAV du premier degr\u00e9","quiz_answer_4":"il existe un BAV du second degr\u00e9","quiz_answer_5":"il existe un BAV du troisi\u00e8me degr\u00e9","correct_answer":["A","B"],"ecg_image":10074,"ecg_description":"On retrouve initialement un rythme sinusal \u00e0 57 battements\/minute avec une conduction atrio-ventriculaire normale (espace PR normal); on retrouve ensuite un ralentissement de la fr\u00e9quence cardiaque avec bradycardie sinusale \u00e0 28 battements\/minute;","ecg_info_box":"Le bloc sino-auriculaire du premier degr\u00e9 n\u2019induit pas de bradycardie; le bloc sino-auriculaire du second degr\u00e9 type 2 est identifi\u00e9 gr\u00e2ce \u00e0 la pr\u00e9sence de pauses sinusales d\u2019une dur\u00e9e \u00e9gale \u00e0 un multiple du cycle de base; dans le bloc sino-auriculaire du troisi\u00e8me degr\u00e9, aucune activit\u00e9 sinusale n\u2019est identifiable. ","commentary_ecg":"Devant un trac\u00e9 de dysfonction sinusale, il est souvent difficile de diff\u00e9rencier sur l\u2019\u00e9lectrocardiogramme de surface 1) une baisse de l\u2019automatisme et 2) une anomalie de conduction de l\u2019influx (bloc sino-auriculaire). Seule la d\u00e9polarisation effective des oreillettes (onde P) est enregistr\u00e9e alors que les influx en provenance du sinus ne le sont pas. Les raisonnements pour d\u00e9terminer le m\u00e9canisme impliqu\u00e9 sont indirects et bas\u00e9s sur la position respective des ondes P.\r\n\r\nL\u2019aspect de ce trac\u00e9 est compatible avec le diagnostic de bloc sino-auriculaire du deuxi\u00e8me degr\u00e9, un influx sur 2 \u00e9tant bloqu\u00e9 (bloc sino-auriculaire 2\/1). En effet, la baisse de fr\u00e9quence cardiaque est brutale avec un espace PP approximativement doubl\u00e9 par rapport au pr\u00e9c\u00e9dent.\r\n\r\nSur le plan th\u00e9orique, il est possible de diff\u00e9rencier (en pratique difficile voire impossible et sujet \u00e0 controverses) 3 degr\u00e9s de bloc sino-auriculaire (par analogie au bloc auriculo-ventriculaire) :\r\n\r\n1. Le bloc sino-auriculaire du premier degr\u00e9 qui est non identifiable sur l\u2019\u00e9lectrocardiogramme de surface, les ondes P apparaissant normales et r\u00e9guli\u00e8rement espac\u00e9es; la transmission de l\u2019influx sinusal est juste ralentie entre le sinus et les oreillettes;\r\n\r\n2.\t Le bloc sino-auriculaire du second degr\u00e9 qui correspond \u00e0 une interruption intermittente de la transmission sino-auriculaire; l\u2019\u00e9lectrocardiogramme est caract\u00e9ris\u00e9 par des absences isol\u00e9es d\u2019activit\u00e9s atriales; on distingue le bloc sino- auriculaire du deuxi\u00e8me degr\u00e9 type 1 (Wenckebach), l\u2019intervalle PP diminuant avant l\u2019activit\u00e9 atriale manquante et le bloc sino-auriculaire du deuxi\u00e8me degr\u00e9 type II (Mobitz 2), l\u2019intervalle PP restant constant jusqu\u2019\u00e0 la perte d\u2019une ou plusieurs activit\u00e9s atriales; la pause qui en r\u00e9sulte correspond au double ou \u00e0 un multiple de l\u2019intervalle normal; ce second aspect (Mobitz 2) est le type de bloc sino-auriculaire le plus commun\u00e9ment observ\u00e9 et le seul qui soit identifiable ais\u00e9ment;\r\n\r\n3.\t Le bloc sino-auriculaire du troisi\u00e8me degr\u00e9 qui correspond \u00e0 l\u2019interruption permanente de la transmission de l\u2019influx entre le sinus et l\u2019oreillette droite; l\u2019\u00e9lectrocardiogramme est caract\u00e9ris\u00e9 par l\u2019absence d\u2019onde P et la pr\u00e9sence fr\u00e9quente d\u2019un \u00e9chappement jonctionnel. Les 2 trac\u00e9s pr\u00e9c\u00e9dents peuvent correspondre \u00e0 ce m\u00e9canisme.\r\n","ecg_info_post_answer":"\"\""},"yoast_head":"\nTrac\u00e9 2.4: Bloc sino-auriculaire - 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-2-4-bloc-sino-auriculaire\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 2.4: Bloc sino-auriculaire - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-4-bloc-sino-auriculaire\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-01T11:25:47+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-2-4-bloc-sino-auriculaire\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-2-4-bloc-sino-auriculaire\/\",\"name\":\"Trac\u00e9 2.4: Bloc sino-auriculaire - 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