{"id":10077,"date":"2026-04-01T11:27:20","date_gmt":"2026-04-01T11:27:20","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10077"},"modified":"2026-04-01T11:27:21","modified_gmt":"2026-04-01T11:27:21","slug":"trace-2-5-pause-sinusale","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-5-pause-sinusale\/","title":{"rendered":"Trac\u00e9 2.5: Pause sinusale"},"content":{"rendered":"","protected":false},"featured_media":10076,"template":"","ecg_case_type":[251],"language_ecgcase":[259],"class_list":["post-10077","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 2.5: Pause sinusale","patient_description":"Homme de 83 ans, hypertendu trait\u00e9 par b\u00e9tabloquant, hospitalis\u00e9 dans le cadre de li\u00ad pothymies r\u00e9p\u00e9t\u00e9es avec chute; mise en \u00e9vidence d\u2019une pause prolong\u00e9e lors de l\u2019\u00e9lectrocardiogramme d\u2019entr\u00e9e","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 un BAV 3 paroxystique","quiz_answer_3":"il existe une pause sinusale","quiz_answer_4":"l\u2019ECG montre une fibrillation auriculaire lente","quiz_answer_5":"il existe un BAV du second degr\u00e9","correct_answer":["A","C"],"ecg_image":10076,"ecg_description":"Le rythme est initialement sinusal (ondes P positives en DII, V5, V6 et n\u00e9gative en aVR, peu volt\u00e9e en DI) avec bradycardie \u00e0 43 bpm; QRS fin; espace QTc normal; survenue d\u2019une pause sinusale prolong\u00e9e de 6 secondes puis reprise du rythme sinusal avec bradycardie \u00e0 45 bpm;","ecg_info_box":"Devant une bradycardie paroxystique, 2 types de pathologies doivent \u00eatre diff\u00e9renci\u00e9es: la dysfonction sinusale et le bloc auriculo-ventriculaire; en effet, l\u2019existence d\u2019une pause ventriculaire (ralentissement brutal de la fr\u00e9quence ventriculaire) chez un patient initialement sinusal peut r\u00e9sulter: \r\n1. D\u2019une dysfonction sinusale paroxystique : absence d\u2019ondes P sur le trac\u00e9; \r\n2. D\u2019un bloc auriculo-ventriculaire complet paroxystique : pr\u00e9sence d\u2019ondes P bloqu\u00e9es sur le trac\u00e9. ","commentary_ecg":"Ce patient pr\u00e9sente une dysfonction sinusale avec l\u2019existence de pauses paroxystiques, prolong\u00e9es, symptomatiques. L\u2019absence totale d\u2019activit\u00e9 atriale (absence d\u2019ondes P bloqu\u00e9es) conduit au diagnostic de pause sinusale et non de bloc auriculo- ventriculaire.\r\n\r\nDiff\u00e9rents m\u00e9canismes physiopathologiques peuvent expliquer l\u2019existence de cette pause:\r\n\r\n1. Baisse de l\u2019automatisme sinusal avec une incapacit\u00e9 du n\u0153ud sinusal d\u2019engendrer une ou plusieurs impulsions; g\u00e9n\u00e9ralement, la pause n\u2019est pas un multiple de l\u2019espace PP pr\u00e9c\u00e9dent;\r\n\r\n2. Anomalie de conduction de l\u2019influx et bloc sino-auriculaire, l\u2019influx naissant normalement dans le n\u0153ud sinusal mais n\u2019\u00e9tant pas transmis aux cellules myocardiques auriculaires adjacentes (maladie p\u00e9ri-sinusale avec bloc de sortie permanent ou intermittent);\r\n\r\n3. Hypertonie vagale; devant la mise en \u00e9vidence d\u2019une pause sinusale paroxystique, il est imp\u00e9ratif de rechercher un facteur d\u00e9clenchant (contexte vagal, douleur violente, peur, stress, miction...) \u00e0 cette pause pour essayer de diff\u00e9rentier patients pr\u00e9sentant une r\u00e9elle dysfonction sinusale anatomique (fibrose...) ou \u00e9lectrophysiologique (incapacit\u00e9 des cellules sinusales \u00e0 se d\u00e9polariser spontan\u00e9ment) et patients pr\u00e9sentant une pause r\u00e9flexe survenant dans un contexte vagal (allongement de la pente de d\u00e9polarisation spontan\u00e9e des cellules sinusales ou bloc de conduction de l\u2019activit\u00e9 sinusale en rapport avec un coup de frein vagal), les cons\u00e9quences th\u00e9rapeutiques diff\u00e9rant compl\u00e9tement.\r\n\r\nLa fronti\u00e8re entre bloc sino-auriculaire (d\u00e9faut de transmission de l\u2019impulsion) et arr\u00eat sinusal (absence d\u2019impulsion) est difficile \u00e0 \u00e9tablir en l\u2019absence de m\u00e9thodes d\u2019enregistrement valables de l\u2019activit\u00e9 \u00e9lectrique du n\u0153ud sinusal. Cette distinction devient impossible quand aucune onde P d\u2019origine sinusale n\u2019est visualisable sur l\u2019\u00e9lectrocardiogramme.\r\n\r\nChez ce patient, il est probable que la dysfonction sinusale soit en rapport avec une atteinte d\u00e9g\u00e9n\u00e9rative idiopathique li\u00e9e \u00e0 l\u2019\u00e2ge major\u00e9e par l\u2019introduction du traitement par b\u00e9tabloquant. L\u2019arr\u00eat de ce traitement n\u2019a pas permis de supprimer les \u00e9pisodes symptomatiques (pas de contexte \u00e9vocateur d\u2019un contexte vagal) et un stimulateur cardiaque a \u00e9t\u00e9 implant\u00e9.","ecg_info_post_answer":"\"\""},"yoast_head":"\nTrac\u00e9 2.5: Pause sinusale - 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-2-5-pause-sinusale\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 2.5: Pause sinusale - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-5-pause-sinusale\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-01T11:27:21+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-2-5-pause-sinusale\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-2-5-pause-sinusale\/\",\"name\":\"Trac\u00e9 2.5: Pause sinusale - 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