{"id":10127,"date":"2026-04-02T15:40:27","date_gmt":"2026-04-02T15:40:27","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10127"},"modified":"2026-04-02T15:40:27","modified_gmt":"2026-04-02T15:40:27","slug":"trace-4-8-defauts-de-detection-ventriculaire","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-4-8-defauts-de-detection-ventriculaire\/","title":{"rendered":"Trac\u00e9 4.8: D\u00e9fauts de d\u00e9tection ventriculaire"},"content":{"rendered":"","protected":false},"featured_media":10126,"template":"","ecg_case_type":[253],"language_ecgcase":[259],"class_list":["post-10127","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-cardiac-pacing","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 4.8: D\u00e9fauts de d\u00e9tection ventriculaire","patient_description":"Homme implant\u00e9 d\u2019un stimulateur fonctionnant en mode VVI dans le cadre d\u2019une maladie de l\u2019oreillette (alternance entre dysfonction sinusale et \u00e9pisodes de fibrillation auriculai\u00ad re); \u00e9lectrocardiogramme de contr\u00f4le","quiz_question":"Concernant cet ECG, quelle(s) est(sont) la(les) r\u00e9ponse(s) vraie(s)?","quiz_answer_1":"le rythme est sinusal","quiz_answer_2":"il existe une dysfonction sinusale","quiz_answer_3":"il existe une fibrillation auriculaire","quiz_answer_4":"il existe un d\u00e9faut de capture ventriculaire","quiz_answer_5":"il existe un d\u00e9faut de d\u00e9tection ventriculaire","correct_answer":["C","E"],"ecg_image":10126,"ecg_description":"L\u2019\u00e9lectrocardiogramme montre une fibrillation auriculaire; les QRS spontan\u00e9s ne sont pas d\u00e9tect\u00e9s et n\u2019inhibent pas la stimulation ventriculaire qui est efficace; d\u00e9fauts de d\u00e9tection ventriculaire;","ecg_info_box":"Une sous-d\u00e9tection atriale ou ventriculaire se traduit sur l\u2019\u00e9lectrocardiogramme par l\u2019existence d\u2019art\u00e9facts de stimulation \u00e0 fr\u00e9quence fixe en d\u00e9pit de l\u2019existence de complexes spontan\u00e9s qui n\u2019inhibent pas la stimulation.","commentary_ecg":"Ce trac\u00e9 r\u00e9v\u00e8le une sous-d\u00e9tection ventriculaire entrainant parfois une stimulation en p\u00e9riode vuln\u00e9rable. En l\u2019absence de d\u00e9tection correcte, le stimulateur fonctionne en mode asynchrone avec impossibilit\u00e9 d\u2019inhibition sur les ventricules spontan\u00e9s. Il existe un risque th\u00e9orique faible mais non nul d\u2019induction d\u2019une arythmie ventriculaire polymorphe maligne compromettant la survie du patient. De plus cette stimulation inutile entraine une consommation d\u2019\u00e9nergie pr\u00e9judiciable pour la dur\u00e9e de vie de l\u2019appareil.\r\n\r\nLa sensibilit\u00e9 exprim\u00e9e en millivolt (mV) qualifie la capacit\u00e9 du stimulateur cardiaque \u00e0 correctement d\u00e9tecter les \u00e9v\u00e9nements cardiaques spontan\u00e9s. Un stimulateur cardiaque est muni de filtres d\u2019entr\u00e9e qui permettent de d\u00e9tecter sp\u00e9cifiquement ondes P dans l\u2019oreillette et ondes R dans le ventricule en fonction de l\u2019analyse de trois caract\u00e9ristiques de ces signaux \u00e9lectriques: le spectre de fr\u00e9quence, la pente et l\u2019amplitude.\r\n\r\nUne programmation ad\u00e9quate du niveau de sensibilit\u00e9 doit permettre de d\u00e9tecter tous les \u00e9v\u00e9nements cardiaques spontan\u00e9s survenant dans la chambre implant\u00e9e tout en ne d\u00e9tectant pas les \u00e9v\u00e9nements d\u2019autre nature (\u00e9coute crois\u00e9e avec d\u00e9tection de signaux cardiaques provenant de l\u2019autre chambre, myopotentiels, interf\u00e9rences\u2026). La programmation d\u2019une d\u00e9tection bipolaire permet d\u2019augmenter la sp\u00e9cificit\u00e9 de la d\u00e9tection par rapport \u00e0 une d\u00e9tection unipolaire en limitant le risque d\u2019\u00e9coute de signaux extracardiaques ou d\u2019\u00e9coute crois\u00e9e et permet la programmation de valeurs de sensibilit\u00e9 \u00e9lev\u00e9e. En revanche, en configuration unipolaire, le risque d\u2019\u00e9coute crois\u00e9e ou d\u2019\u00e9coute de signaux extracardiaques oblige \u00e0 la programmation de niveau de sensibilit\u00e9 moindre avec un risque accru de sous-d\u00e9tection.\r\n\r\nTraditionnellement, \u00e0 la diff\u00e9rence des d\u00e9fibrillateurs, les stimulateurs fonctionnaient avec une sensibilit\u00e9 stable et fixe sur l\u2019ensemble du cycle cardiaque. De plus en plus, m\u00eame si les contraintes en termes de d\u00e9tection ne sont pas les m\u00eames (n\u00e9cessit\u00e9 cruciale pour un d\u00e9fibrillateur de d\u00e9tecter et traiter des troubles du rythme ventriculaire tr\u00e8s rapides, polymorphes et microvolt\u00e9s), les stimulateurs modernes permettent une sensibilit\u00e9 adaptative (niveau de sensibilit\u00e9 variable en fonction de l\u2019amplitude de l\u2019onde R ou de l\u2019onde P d\u00e9tect\u00e9e) avec augmentation progressive de la sensibilit\u00e9 au cours du cycle cardiaque (possibilit\u00e9 de d\u00e9tecter des signaux de petite amplitude sans surd\u00e9tecter l\u2019onde T).\r\n\r\nLa programmation d\u2019une sensibilit\u00e9 ventriculaire adaptative plus adapt\u00e9e a permis de corriger le probl\u00e8me chez ce patient.\r\n","ecg_info_post_answer":"<img class=\"alignnone wp-image-10314 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-175-1024x579.png\" alt=\"\" width=\"800\" height=\"452\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 4.8: D\u00e9fauts de d\u00e9tection ventriculaire - 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-4-8-defauts-de-detection-ventriculaire\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 4.8: D\u00e9fauts de d\u00e9tection ventriculaire - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-4-8-defauts-de-detection-ventriculaire\/\" \/>\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-4-8-defauts-de-detection-ventriculaire\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-4-8-defauts-de-detection-ventriculaire\/\",\"name\":\"Trac\u00e9 4.8: D\u00e9fauts de d\u00e9tection ventriculaire - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-4-8-defauts-de-detection-ventriculaire\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-4-8-defauts-de-detection-ventriculaire\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-4-8-ecg-6-scaled-e1775144353165.jpeg\",\"datePublished\":\"2026-04-02T15:40:27+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-4-8-defauts-de-detection-ventriculaire\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-4-8-defauts-de-detection-ventriculaire\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-4-8-defauts-de-detection-ventriculaire\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-4-8-ecg-6-scaled-e1775144353165.jpeg\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-4-8-ecg-6-scaled-e1775144353165.jpeg\",\"width\":2560,\"height\":1535},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-4-8-defauts-de-detection-ventriculaire\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 4.8: D\u00e9fauts de d\u00e9tection ventriculaire\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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