{"id":10081,"date":"2026-04-01T11:29:00","date_gmt":"2026-04-01T11:29:00","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10081"},"modified":"2026-04-01T11:29:00","modified_gmt":"2026-04-01T11:29:00","slug":"trace-2-6-diagnostic-differentiel-dune-dysfonction-sinusale","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-6-diagnostic-differentiel-dune-dysfonction-sinusale\/","title":{"rendered":"Trac\u00e9 2.6: Diagnostic diff\u00e9rentiel d\u2019une dysfonction sinusale"},"content":{"rendered":"","protected":false},"featured_media":10400,"template":"","ecg_case_type":[251],"language_ecgcase":[259],"class_list":["post-10081","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 2.6: Diagnostic diff\u00e9rentiel d\u2019une dysfonction sinusale","patient_description":"Homme de 67 ans, pr\u00e9sentant des ant\u00e9c\u00e9dents de fibrillation atriale, adress\u00e9 dans le ser\u00ad vice pour diagnostic suspect\u00e9 de bradycardie sinusale avec rythme irr\u00e9gulier","quiz_question":"Concernant cet ECG, quelle(s) est(sont) la(les) r\u00e9ponse(s) vraie(s)?","quiz_answer_1":"il existe une bradycardie sinusale","quiz_answer_2":"il existe un BAV du second degr\u00e9","quiz_answer_3":"il existe une dysfonction sinusale","quiz_answer_4":"on retrouve des extrasystoles atriales bloqu\u00e9es","quiz_answer_5":"on retrouve un BAV du premier degr\u00e9","correct_answer":["D"],"ecg_image":10400,"ecg_description":"Ce patient pr\u00e9sente une activit\u00e9 atriale sinusale (positive en DI, DII, V5, V6 et n\u00e9gative en aVR); on peut voir dans la partie initiale de l\u2019onde T, une activit\u00e9 atriale ectopique correspondant \u00e0 une extrasystole atriale bloqu\u00e9e (non suivie d\u2019un QRS) avec pause sinusale post-extrasystolique expliquant la pseudo-bradycardie sinusale;","ecg_info_box":"Une extrasystole atriale tr\u00e8s pr\u00e9coce 1) peut \u00eatre difficile \u00e0 identifier sur l\u2019\u00e9lectrocardiogramme car \u201ccach\u00e9e\u201d dans l\u2019onde T et bloqu\u00e9e donc non suivie d\u2019un complexe QRS 2) constitue le diagnostic diff\u00e9rentiel de pause sinusale 3) peut provenir d\u2019un foyer situ\u00e9 \u00e0 l\u2019ostium d\u2019une des veines pulmonaires et \u00eatre la g\u00e2chette favorisant l\u2019induction d\u2019un \u00e9pisode d\u2019arythmie atriale. ","commentary_ecg":"Ce patient \u00e9tait donc adress\u00e9 dans le cadre d\u2019une irr\u00e9gularit\u00e9 de fr\u00e9quence et de pauses sinusales. Une inspection minutieuse du trac\u00e9 permet de mettre en \u00e9vidence une encoche dans l\u2019onde T pr\u00e9c\u00e9dant la pause correspondant \u00e0 une extrasystole atriale bloqu\u00e9e expliquant la pause post-extrasystolique qui suit. Il ne s\u2019agit donc pas d\u2019un probl\u00e8me de baisse de l\u2019automatisme (dysfonction sinusale et discussion sur l\u2019int\u00e9r\u00eat d\u2019implantation d\u2019un stimulateur cardiaque) mais au contraire d\u2019un hyper- automatisme (extrasystole atriale et discussion sur l\u2019int\u00e9r\u00eat d\u2019un traitement anti- arythmique). Une extrasystole atriale bloqu\u00e9e constitue donc le diagnostic diff\u00e9rentiel de dysfonction sinusale qui doit \u00eatre syst\u00e9matiquement recherch\u00e9 devant l\u2019existence d\u2019une pause, les cons\u00e9quences th\u00e9rapeutiques \u00e9tant oppos\u00e9es.\r\n\r\n","ecg_info_post_answer":"<img class=\"alignnone wp-image-10301 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-085-1024x555.png\" alt=\"\" width=\"800\" height=\"434\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 2.6: Diagnostic diff\u00e9rentiel d\u2019une dysfonction 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-2-6-diagnostic-differentiel-dune-dysfonction-sinusale\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 2.6: Diagnostic diff\u00e9rentiel d\u2019une dysfonction sinusale - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-6-diagnostic-differentiel-dune-dysfonction-sinusale\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\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-2-6-diagnostic-differentiel-dune-dysfonction-sinusale\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-2-6-diagnostic-differentiel-dune-dysfonction-sinusale\/\",\"name\":\"Trac\u00e9 2.6: Diagnostic diff\u00e9rentiel d\u2019une dysfonction sinusale - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-2-6-diagnostic-differentiel-dune-dysfonction-sinusale\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-2-6-diagnostic-differentiel-dune-dysfonction-sinusale\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-2-6-ecg-scaled.jpeg\",\"datePublished\":\"2026-04-01T11:29:00+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-2-6-diagnostic-differentiel-dune-dysfonction-sinusale\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-2-6-diagnostic-differentiel-dune-dysfonction-sinusale\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-2-6-diagnostic-differentiel-dune-dysfonction-sinusale\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-2-6-ecg-scaled.jpeg\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-2-6-ecg-scaled.jpeg\",\"width\":2560,\"height\":1713},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-2-6-diagnostic-differentiel-dune-dysfonction-sinusale\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 2.6: Diagnostic diff\u00e9rentiel d\u2019une dysfonction sinusale\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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