{"id":10129,"date":"2026-04-02T15:46:11","date_gmt":"2026-04-02T15:46:11","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10129"},"modified":"2026-04-02T15:46:12","modified_gmt":"2026-04-02T15:46:12","slug":"trace-4-9-tachycardie-par-reentree-electronique","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-4-9-tachycardie-par-reentree-electronique\/","title":{"rendered":"Trac\u00e9 4.9: Tachycardie par r\u00e9entr\u00e9e \u00e9lectronique"},"content":{"rendered":"","protected":false},"featured_media":10128,"template":"","ecg_case_type":[253],"language_ecgcase":[259],"class_list":["post-10129","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 4.9: Tachycardie par r\u00e9entr\u00e9e \u00e9lectronique","patient_description":"Homme de 79 ans implant\u00e9 d\u2019un stimulateur double chambre Medtronic pour bloc auriculo- ventriculaire complet; 3 jours apr\u00e8s sa sortie, consultation aux urgences pour palpitations; enregistrement de ce trac\u00e9; programmation en mode DDD","quiz_question":"Concernant cet ECG, quelle(s) est(sont) la(les) r\u00e9ponse(s) vraie(s)?","quiz_answer_1":"les QRS sont spontan\u00e9s","quiz_answer_2":"les QRS sont stimul\u00e9s","quiz_answer_3":"il s\u2019agit d\u2019une tachycardie ventriculaire","quiz_answer_4":"il s\u2019agit d\u2019un flutter atrial conduit en 2\/1","quiz_answer_5":"il peut s\u2019agir d\u2019une tachycardie par r\u00e9entr\u00e9e \u00e9lectronique","correct_answer":["B","E"],"ecg_image":10128,"ecg_description":"Tachycardie \u00e0 QRS large; une analyse minutieuse du trac\u00e9 permet de mettre en \u00e9vidence un art\u00e9fact de stimulation de petite amplitude de V3 \u00e0 V5; il s\u2019agit donc d\u2019une tachycardie \u00e9lectro-entrain\u00e9e (stimulation ventriculaire); diff\u00e9rentes hypoth\u00e8ses peuvent \u00eatre envisag\u00e9es: arythmie supra- ventriculaire suivie \u00e0 la fr\u00e9quence maximale, tachycardie par r\u00e9entr\u00e9e \u00e9lectronique, tachycardie sinusale; l\u2019activit\u00e9 atriale est difficile \u00e0 identifier pour permettre d\u2019affiner le diagnostic;\r\n","ecg_info_box":"Le diagnostic \u00e9lectrocardiographique de tachycardie par r\u00e9entr\u00e9e \u00e9lectronique est bas\u00e9 sur la mise en \u00e9vidence d\u2019une tachycardie avec stimulation ventriculaire (QRS large avec art\u00e9fact de stimulation) et conduction atriale r\u00e9trograde (ondes P\u2019 n\u00e9gatives dans les d\u00e9rivations inf\u00e9rieures). Ce diagnostic peut parfois \u00eatre difficile (art\u00e9facts et ondes P\u2019 difficilement identifiables) mais doit \u00eatre syst\u00e9matiquement \u00e9voqu\u00e9 devant une tachycardie r\u00e9guli\u00e8re \u00e0 QRS large chez un patient implant\u00e9. ","commentary_ecg":"Une tachycardie par r\u00e9entr\u00e9e \u00e9lectronique (TRE) est le terme utilis\u00e9 pour d\u00e9finir une tachycardie \u00e9lectro-entrain\u00e9e le plus souvent \u00e0 la fr\u00e9quence maximale de stimulation avec r\u00e9p\u00e9tition de s\u00e9quences stimulation ventriculaire - conduction atriale r\u00e9trograde. L\u2019entretien d\u2019une TRE r\u00e9sulte de la d\u00e9tection hors p\u00e9riodes r\u00e9fractaires d\u2019une onde P\u2019 r\u00e9trograde qui entraine le d\u00e9clenchement d\u2019un d\u00e9lai AV souvent allong\u00e9, qui favorise de nouveau la conduction r\u00e9trograde apr\u00e8s stimulation ventriculaire. Une TRE est donc une s\u00e9quence r\u00e9p\u00e9titive dans laquelle le stimulateur r\u00e9agit \u00e0 chaque onde P\u2019 r\u00e9trograde en stimulant le ventricule \u00e0 une fr\u00e9quence \u00e9lev\u00e9e qui \u00e0 son tour g\u00e9n\u00e8re une onde P\u2019 r\u00e9trograde. Le cycle se r\u00e9p\u00e8te ainsi ind\u00e9finiment \u00e0 moins de l\u2019apparition d\u2019un bloc r\u00e9trograde ou de l\u2019intervention d\u2019un algorithme sp\u00e9cifique du stimulateur. \r\n\r\nL\u2019existence d\u2019une conduction r\u00e9trograde est donc un pr\u00e9alable indispensable au d\u00e9marrage et \u00e0 l\u2019entretien d\u2019une TRE. La conduction r\u00e9trograde est pr\u00e9sente en moyenne chez 40% des patients stimul\u00e9s au repos, toutes indications confondues. Elle est beaucoup plus fr\u00e9quente chez les patients implant\u00e9s pour dysfonction sinusale que pour bloc auriculo-ventriculaire. Ces chiffres sont suffisamment \u00e9lev\u00e9s pour justifier d\u2019une protection efficace \u00e0 programmer syst\u00e9matiquement. En plus de la perm\u00e9abilit\u00e9 de la conduction r\u00e9trograde, le d\u00e9marrage d\u2019une TRE implique la programmation d\u2019un mode de suivi atrial (DDD ou VDD) et une perte momentan\u00e9e ou permanente de la synchronisation atrio-ventriculaire. En effet, si l\u2019activit\u00e9 ventriculaire est correctement synchronis\u00e9e \u00e0 celle de l\u2019oreillette, la conduction r\u00e9trograde est bloqu\u00e9e. Les \u00e9v\u00e9nements suivants peuvent favoriser une dissociation auriculo-ventriculaire temporaire, une conduction r\u00e9trograde et le d\u00e9clenchement d\u2019une TRE: une extrasystole ventriculaire (cause la plus fr\u00e9quente), une extrasystole atriale avec allongement du d\u00e9lai AV pour respecter la fr\u00e9quence cardiaque maximale programm\u00e9e, un d\u00e9lai AV programm\u00e9 trop long (la voie nodo-hissienne est sortie de sa p\u00e9riode r\u00e9fractaire au moment de la stimulation ventriculaire), une interf\u00e9rence externe ou des myopotentiels d\u00e9tect\u00e9s par la chaine atriale, un d\u00e9faut de d\u00e9tection ou de stimulation atriale...\r\n\r\nLes premiers stimulateurs n\u2019\u00e9taient pas prot\u00e9g\u00e9s contre ce type d\u2019emballement et la tachycardie pouvait durer ind\u00e9finiment et g\u00e9n\u00e9rer une symptomatologie parfois tr\u00e8s invalidante. Une TRE de dur\u00e9e prolong\u00e9e peut en effet \u00eatre mal support\u00e9e avec une symptomatologie allant de la simple sensation de mal \u00eatre ou de palpitations jusqu\u2019\u00e0 la d\u00e9compensation cardiaque chez les patients pr\u00e9sentant une cardiopathie sous-jacente.","ecg_info_post_answer":"\"\"\r\n\r\nDescription trac\u00e9<\/strong>\r\n\r\nL\u2019analyse de l\u2019EGM permet de confirmer le diagnostic de tachycardie par r\u00e9entr\u00e9e \u00e9lectronique: succession ininterrompue de cycles VP-AS (stimulation ventriculaire, d\u00e9tection atriale) avec allongement du d\u00e9lai AV pour ne pas d\u00e9passer la fr\u00e9quence maximale de suivi;"},"yoast_head":"\nTrac\u00e9 4.9: Tachycardie par r\u00e9entr\u00e9e \u00e9lectronique - 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-4-9-tachycardie-par-reentree-electronique\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 4.9: Tachycardie par r\u00e9entr\u00e9e \u00e9lectronique - 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