{"id":10097,"date":"2026-04-01T11:48:37","date_gmt":"2026-04-01T11:48:37","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10097"},"modified":"2026-04-09T07:45:49","modified_gmt":"2026-04-09T07:45:49","slug":"trace-3-5-bloc-de-branche-droit-complet","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-5-bloc-de-branche-droit-complet\/","title":{"rendered":"Trac\u00e9 3.5: Bloc de branche droit complet"},"content":{"rendered":"","protected":false},"featured_media":10096,"template":"","ecg_case_type":[252],"language_ecgcase":[259],"class_list":["post-10097","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 3.5: Bloc de branche droit complet","patient_description":"Homme de 24 ans asymptomatique","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) vrai(s) pour cet ECG?","quiz_answer_1":"h\u00e9mibloc ant\u00e9rieur gauche","quiz_answer_2":"h\u00e9mibloc post\u00e9rieur gauche","quiz_answer_3":"bloc de branche droit complet","quiz_answer_4":"bloc de branche gauche complet","quiz_answer_5":"bloc de branche indiff\u00e9renci\u00e9","correct_answer":["C"],"ecg_image":10096,"ecg_description":"Rythme sinusal, aspect typique de bloc de branche droit complet: dur\u00e9e de QRS: 130 ms; V1: aspect rSR\u2019, retard de la d\u00e9flexion intrins\u00e9co\u00efde, onde T n\u00e9gative; V6: aspect qRS avec onde q septale et large onde S trainante","ecg_info_box":"-","commentary_ecg":"Ce patient pr\u00e9sente un bloc de branche droit complet sur coeur sain. La conduction \u00e9lectrique \u00e9tant interrompue dans la branche droite, l\u2019activation du ventricule gauche se fait normalement tandis que celle du ventricule droit est retard\u00e9e. Le complexe QRS peut \u00eatre divis\u00e9 en 2 parties : la premi\u00e8re moiti\u00e9 correspond aux vecteurs l\u2019activation du ventricule gauche et la deuxi\u00e8me moiti\u00e9 aux vecteurs d\u2019activation du ventricule droit.\r\n\r\nL\u2019activation ventriculaire d\u00e9bute normalement \u00e0 la partie moyenne de la face gauche du septum ; les vecteurs suivants sont \u00e9galement normaux car l\u2019activation de la masse ventriculaire gauche pr\u00e9domine; en revanche, l\u2019activation tardive du ventricule droit ajoute en fin du QRS des vecteurs anormaux dirig\u00e9s vers la droite qui d\u00e9forment consid\u00e9rablement la partie terminale du QRS.\r\n\r\nLa face gauche du septum inter-ventriculaire est donc activ\u00e9e la premi\u00e8re, \u00e0 sa partie m\u00e9diane et haute, comme dans l\u2019activation ventriculaire normale. Le septum s\u2019active normalement de gauche \u00e0 droite. On retrouve une positivit\u00e9 initiale en V1 (onde r) et une n\u00e9gativit\u00e9 initiale en V6 (onde q). L\u2019activation du ventricule gauche n\u2019est pas modifi\u00e9e par rapport \u00e0 la normale et suit imm\u00e9diatement l\u2019activation septale. Elle se fait de l\u2019endocarde vers l\u2019\u00e9picarde et on retrouve une positivit\u00e9 ample en V6 (onde R) et une n\u00e9gativit\u00e9 (onde S) en V1 qui suit la positivit\u00e9 initiale du complexe QRS normal.\r\n\r\nLe temps de travers\u00e9e du septum par voie musculaire est souvent prolong\u00e9 et contribue \u00e0 l\u2019\u00e9largissement du QRS. L\u2019activation du ventricule droit se fait alors par conduction musculaire lente. Cette activation retard\u00e9e du ventricule droit se traduit sur l\u2019\u00e9lectrocardiogramme par une onde positive en V1 (R\u2019) souvent de grande amplitude et une onde n\u00e9gative en V6 (S), car il n\u2019y a plus d\u2019opposition des potentiels \u00e9lectriques ventriculaires gauches dont l\u2019activation est termin\u00e9e. L\u2019aspect \u00e9lectrocardiographique caract\u00e9ristique du bloc de branche droit associe donc :\r\n\r\n1) un complexe QRS \u00e9largi \u00e0 120 ms ou plus chez l\u2019adulte, un QRS sup\u00e9rieur \u00e0 100 ms chez l\u2019enfant de moins de 8 ans ;\r\n\r\n2) une apparition retard\u00e9e de la d\u00e9flexion intrins\u00e9co\u00efde (temps d\u2019activation ventriculaire) dans les d\u00e9rivations pr\u00e9cordiales droites : elle est due \u00e0 la d\u00e9polarisation retard\u00e9e de la paroi ventriculaire impliqu\u00e9e ; il s\u2019agit d\u2019un crit\u00e8re majeur et fondamental de bloc de branche droit ; la d\u00e9flexion intrins\u00e9co\u00efde est normale dans les pr\u00e9cordiales gauches puisque le ventricule gauche est activ\u00e9 normalement ;\r\n\r\n3) un aspect QRS caract\u00e9ristique en V1 et V2 : on retrouve une positivit\u00e9 tardive g\u00e9n\u00e9ralement de grande amplitude ; la premi\u00e8re d\u00e9flexion enregistr\u00e9e est positive (onde R) et correspond \u00e0 la d\u00e9polarisation septale dirig\u00e9e de gauche \u00e0 droite en direction de l\u2019\u00e9lectrode ; elle est suivie d\u2019une onde n\u00e9gative (onde S) lorsque le stimulus se propage dans le ventricule gauche en fuyant l\u2019\u00e9lectrode ; la derni\u00e8re d\u00e9flexion (onde R\u2019) qui est la d\u00e9flexion intrins\u00e9co\u00efde correspond \u00e0 l\u2019activation retard\u00e9 du ventricule droit : elle est dirig\u00e9e vers l\u2019\u00e9lectrode ; l\u2019activation du ventricule droit n\u2019est plus en opposition avec la d\u00e9polarisation du ventricule gauche, il en r\u00e9sulte un potentiel de grande amplitude avec R\u2019 > R ; on retrouve donc soit un aspect rsR\u2019 ou rSR\u2019 ou rR\u2019 ;\r\n\r\n4) un aspect caract\u00e9ristique en V6 : on peut retrouver une onde q de d\u00e9polarisation septale normale (elle peut \u00eatre absente en fonction des diff\u00e9rences de morphologie et d\u2019orientation du coeur) et une onde S large et trainante correspondant \u00e0 la d\u00e9polarisation tardive du septum droit et de la cavit\u00e9 ventriculaire droite ;\r\n\r\n5) une modification du segment ST et de l\u2018onde T en V1, V2 : on peut observer un segment ST sous-d\u00e9cal\u00e9 et une onde T invers\u00e9e ; la d\u00e9polarisation \u00e9tant modifi\u00e9e, il existe en r\u00e9ponse des troubles de la repolarisation ; onde T positive en V6 ;\r\n\r\n6) dans le plan frontal, la premi\u00e8re partie du QRS a une morphologie et une orientation normale tandis que la seconde moiti\u00e9 a une orientation axiale d\u00e9vi\u00e9e vers la droite. L\u2019axe \u00e9lectrique du QRS est fonction de la direction plus ou moins divergente des vecteurs r\u00e9sultants de la premi\u00e8re moiti\u00e9 et de la seconde moiti\u00e9 du QRS. Il est le plus souvent normal ou l\u00e9g\u00e8rement d\u00e9vi\u00e9 \u00e0 droite. Les aspects de bloc de branche droit s\u2019\u00e9loignant du type usuel avec d\u00e9viation axiale majeure sont habituellement li\u00e9s \u00e0 l\u2019adjonction d\u2019un autre facteur comme une hypertrophie ventriculaire, une position verticale du coeur, un h\u00e9mibloc post\u00e9rieur gauche associ\u00e9.","ecg_info_post_answer":"\"\""},"yoast_head":"\nTrac\u00e9 3.5: Bloc de branche droit complet - 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-3-5-bloc-de-branche-droit-complet\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 3.5: Bloc de branche droit complet - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-5-bloc-de-branche-droit-complet\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-09T07:45:49+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-3-5-ecg-4-scaled-e1775043856946-1024x609.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1024\" \/>\n\t<meta property=\"og:image:height\" content=\"609\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-3-5-bloc-de-branche-droit-complet\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-3-5-bloc-de-branche-droit-complet\/\",\"name\":\"Trac\u00e9 3.5: Bloc de branche droit complet - 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