{"id":10089,"date":"2026-04-01T11:34:55","date_gmt":"2026-04-01T11:34:55","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10089"},"modified":"2026-04-09T07:43:01","modified_gmt":"2026-04-09T07:43:01","slug":"trace-3-1-bloc-de-branche-gauche","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-1-bloc-de-branche-gauche\/","title":{"rendered":"Trac\u00e9 3.1: Bloc de branche gauche"},"content":{"rendered":"","protected":false},"featured_media":10088,"template":"","ecg_case_type":[252],"language_ecgcase":[259],"class_list":["post-10089","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-bundle-branch-block","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 3.1: Bloc de branche gauche","patient_description":"Homme de 68 ans avec myocardiopathie isch\u00e9mique et fraction d\u2019\u00e9jection alt\u00e9r\u00e9e \u00e0 25%","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) vrai(s) pour cet ECG?","quiz_answer_1":"rythme sinusal","quiz_answer_2":"BAV 1","quiz_answer_3":"bloc de branche droit + h\u00e9mibloc ant\u00e9rieur gauche","quiz_answer_4":"bloc de branche gauche","quiz_answer_5":"bloc indiff\u00e9renci\u00e9","correct_answer":["A","B","D"],"ecg_image":10088,"ecg_description":"Rythme sinusal, BAV du premier degr\u00e9 (PR long et fixe) avec bloc de branche gauche: largeur du QRS > 120 ms (184 ms); absence d\u2019onde q et onde R large et crochet\u00e9e en DI, aVL, V5 et V6 avec retard de la d\u00e9flexion intrins\u00e9co\u00efde > 60 ms; aspect QS et rS en V1 et V2; sous-d\u00e9calage segment ST et onde T n\u00e9gative en DI, aVL, V5 et V6;","ecg_info_box":"Le bloc de branche gauche se caract\u00e9rise par une perturbation de la totalit\u00e9 des vecteurs de d\u00e9polarisation ventriculaire; l\u2019activation du ventricule droit est normale tandis que celle du ventricule gauche est lente et retard\u00e9e avec inversion du sens d\u2019activation septale. ","commentary_ecg":"Dans le bloc de branche gauche, l\u2019activation du ventricule droit est normale dans son temps et son cheminement tandis que celle du ventricule gauche est retard\u00e9e car elle d\u00e9pend du franchissement du septum de droite \u00e0 gauche \u00e0 partir de la branche droite. L\u2019anomalie fondamentale est donc l\u2019inversion du sens d\u2019activation du septum. A l\u2019inverse du bloc de branche droit o\u00f9 les vecteurs de la premi\u00e8re moiti\u00e9 du QRS sont normaux, le bloc de branche gauche se caract\u00e9rise par une perturbation de la totalit\u00e9 des vecteurs de d\u00e9polarisation ventriculaire. L\u2019activation du ventricule droit habituellement masqu\u00e9e par celle du ventricule gauche devient anormalement visible puisque la d\u00e9polarisation du ventricule gauche est retard\u00e9e. Face au ventricule gauche, on n\u2019enregistre que des potentiels positifs et face au ventricule droit une majorit\u00e9 de potentiels n\u00e9gatifs : l\u2019aspect en V1 est de type QS ou rS et celui de V6 de type R exclusif large. \r\n\r\nLa premi\u00e8re partie du septum \u00e0 \u00eatre activ\u00e9e est le c\u00f4t\u00e9 droit pr\u00e8s de la base du muscle papillaire ant\u00e9rieur du ventricule droit ; l\u2019onde d\u2019activation se propage ensuite dans la masse septale droite moyenne et inf\u00e9rieure de la droite vers la gauche en direction de la pointe du c\u0153ur ; l\u2019activation du septum \u00e9tant invers\u00e9e, le vecteur d\u2019activation septale a une direction oppos\u00e9e \u00e0 la direction habituelle ; les premiers vecteurs de QRS correspondent \u00e0 l\u2019activation de la partie droite du septum et d\u2019une partie du ventricule droit : ils se dirigent en avant, \u00e0 gauche et un peu en bas et donnent une petite positivit\u00e9 initiale \u00e0 la fois en V1 et en V6 ce qui fait dispara\u00eetre l\u2019onde q en V6. \r\n\r\nLes vecteurs suivants correspondent \u00e0 l\u2019activation invers\u00e9e de la partie gauche du septum puis \u00e0 l\u2019activation retard\u00e9e et prolong\u00e9e du ventricule gauche ; ce d\u00e9lai (franchissement de la \u00ab barri\u00e8re septale \u00bb + conduction lente dans le ventricule gauche) conditionne l\u2019allongement de la dur\u00e9e du QRS ; les vecteurs se dirigent \u00e0 gauche et en arri\u00e8re et se traduisent par de grandes d\u00e9flexions positives larges et crochet\u00e9es en V6 et de grandes d\u00e9flexions n\u00e9gatives en V1 et V2.","ecg_info_post_answer":"\"\""},"yoast_head":"\nTrac\u00e9 3.1: Bloc de branche gauche - 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