{"id":10154,"date":"2026-04-02T19:35:39","date_gmt":"2026-04-02T19:35:39","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10154"},"modified":"2026-04-02T19:35:39","modified_gmt":"2026-04-02T19:35:39","slug":"trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/","title":{"rendered":"Trac\u00e9 5.5: Extrasystoles atriales initiant une arythmie atriale"},"content":{"rendered":"","protected":false},"featured_media":10153,"template":"","ecg_case_type":[254],"language_ecgcase":[259],"class_list":["post-10154","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-extrasystoles","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 5.5: Extrasystoles atriales initiant une arythmie atriale","patient_description":"Homme de 64 ans avec ant\u00e9c\u00e9dents de fibrillation atriale paroxystique ; consulte pour pal\u00ad pitations","quiz_question":"Sur cet ECG, on retrouve:","quiz_answer_1":"des extrasystoles atriales","quiz_answer_2":"des extrasystoles atriales bloqu\u00e9es","quiz_answer_3":"une salve de fibrillation auriculaire","quiz_answer_4":"un flutter commun","quiz_answer_5":"une tachycardie jonctionnelle","correct_answer":["A","C"],"ecg_image":10153,"ecg_description":"Sur cet ECG, on retrouve initialement une activit\u00e9 atriale sinusale avec 2 extrasystoles atriales (modifiant nettement l\u2019aspect de l\u2019onde T); les QRS suivant l\u2019extrasystole sont l\u00e9g\u00e8rement modifi\u00e9s avec un degr\u00e9 variable d\u2019aberration de conduction type bloc de branche droit; une extrasystole atriale semblant identique (aspect caract\u00e9ristique P\/T) initie un \u00e9pisode d\u2019arythmie atriale correspondant \u00e0 une fibrillation atriale (activit\u00e9 atriale anarchique, tr\u00e8s rapide); ","ecg_info_box":"Un type particulier d\u2019extrasystoles atriales (reconnaissables \u00e0 leur aspect P\/T) tient un r\u00f4le central dans l\u2019initiation et l\u2019entretien des \u00e9pisodes de fibrillation auriculaire. Cet aspect \u00e9lectrocardiographique caract\u00e9ristique correspond le plus souvent \u00e0 des foyers localis\u00e9s \u00e0 l\u2019ostium des veines pulmonaires.","commentary_ecg":"Ce trac\u00e9 montre un exemple de d\u00e9clenchement d\u2019une arythmie atriale par une extrasystole atriale pr\u00e9coce (survenant sur le sommet de l\u2019onde T) sugg\u00e9rant une origine focale. Les d\u00e9terminants de la gen\u00e8se et du maintien des arythmies atriales sont complexes, multiples et souvent intriqu\u00e9s. La survenue d\u2019extrasystoles atriales a longtemps \u00e9t\u00e9 consid\u00e9r\u00e9e comme une cons\u00e9quence b\u00e9nigne d\u2019une prise excessive de caf\u00e9ine. Ce trac\u00e9 illustre toutefois, le r\u00f4le central dans l\u2019initiation et l\u2019entretien d\u2019\u00e9pisodes de fibrillation auriculaire d\u2019un type particulier d\u2019extrasystoles atriales reconnaissables \u00e0 leur aspect caract\u00e9ristique \u00e9lectrocardiographique P\/T. La FA focale paroxystique pr\u00e9sent\u00e9e par ce patient est la cons\u00e9quence de l\u2019expression de foyers automatiques tr\u00e8s rapides situ\u00e9s le plus souvent \u00e0 l\u2019abouchement des veines pulmonaires. Ces foyers qui bombardent les oreillettes et en d\u00e9sorganisent compl\u00e9tement l\u2019activation, proviennent principalement de l\u2019ostium des veines pulmonaires mais peuvent \u00e9galement provenir de la veine cave sup\u00e9rieure ou inf\u00e9rieure, du ligament de Marshall, de la crista terminalis, du sinus coronaire ou de la partie post\u00e9rieure de l\u2019oreillette gauche. Ces extrasystoles sont tellement pr\u00e9matur\u00e9es qu\u2019elles sont parfois difficilement identifiables, leur mise en \u00e9vidence \u00e9tant bas\u00e9e sur l\u2019existence d\u2019une d\u00e9formation parfois limit\u00e9e de l\u2019onde T. L\u2019axe et la morphologie de l\u2019onde P\u2019 peuvent aider \u00e0 d\u00e9terminer son origine anatomique (veines pulmonaires ou autres foyers, diff\u00e9renciation entre les veines pulmonaires droites ou gauches, inf\u00e9rieures ou sup\u00e9rieures). La raison pour laquelle l\u2019abouchement des veines pulmonaires repr\u00e9sente la source majoritaire des foyers d\u2019extrasystoles initiant l\u2019arythmie, r\u00e9side dans la pr\u00e9sence dans la paroi des veines pulmonaires (surtout les veines sup\u00e9rieures) de fibres myocardiques stri\u00e9es provenant du toit de l\u2019oreillette gauche. Les p\u00e9riodes r\u00e9fractaires de ces cellules sont plus courtes que celles de l\u2019oreillette gauche ce qui peut expliquer en partie leur arhytmog\u00e9n\u00e9icit\u00e9. L\u2019enchev\u00eatrement complexe des infiltrats myocardiques dans la paroi veineuse favorise \u00e9galement l\u2019anisotropie de conduction et favorise la survenue de micro- r\u00e9entr\u00e9es localis\u00e9es. Le r\u00f4le majeur de ces sites arythmog\u00e8nes justifie que les veines pulmonaires soient devenues la cible de techniques ablatives. Le principe de l\u2019ablation de fibrillation atriale consiste \u00e0 \u00e9liminer la g\u00e2chette d\u00e9clenchant l\u2019arythmie (isolation \u00e9lectrique des veines pulmonaires) et \u00e0 modifier le substrat arythmog\u00e8ne atrial. ","ecg_info_post_answer":"\"\""},"yoast_head":"\nTrac\u00e9 5.5: Extrasystoles atriales initiant une arythmie atriale - 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-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 5.5: Extrasystoles atriales initiant une arythmie atriale - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/\" \/>\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-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/\",\"name\":\"Trac\u00e9 5.5: Extrasystoles atriales initiant une arythmie atriale - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-5-ecg-3-scaled.jpeg\",\"datePublished\":\"2026-04-02T19:35:39+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-5-ecg-3-scaled.jpeg\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-5-ecg-3-scaled.jpeg\",\"width\":2560,\"height\":1789},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 5.5: Extrasystoles atriales initiant une arythmie atriale\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker & ICD learning \u2014 built by electrophysiologists\",\"publisher\":{\"@id\":\"https:\/\/cardiocases.com\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/cardiocases.com\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"fr-FR\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/cardiocases.com\/#organization\",\"name\":\"Cardiocases\",\"url\":\"https:\/\/cardiocases.com\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/07\/cardiocases_logo.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/07\/cardiocases_logo.png\",\"width\":1755,\"height\":499,\"caption\":\"Cardiocases\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/#\/schema\/logo\/image\/\"},\"sameAs\":[\"https:\/\/www.linkedin.com\/company\/cardiocases\/\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Trac\u00e9 5.5: Extrasystoles atriales initiant une arythmie atriale - Cardiocases","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/","og_locale":"fr_FR","og_type":"article","og_title":"Trac\u00e9 5.5: Extrasystoles atriales initiant une arythmie atriale - Cardiocases","og_url":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/","og_site_name":"Cardiocases","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/","url":"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/","name":"Trac\u00e9 5.5: Extrasystoles atriales initiant une arythmie atriale - Cardiocases","isPartOf":{"@id":"https:\/\/cardiocases.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/#primaryimage"},"image":{"@id":"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/#primaryimage"},"thumbnailUrl":"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-5-ecg-3-scaled.jpeg","datePublished":"2026-04-02T19:35:39+00:00","breadcrumb":{"@id":"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/#breadcrumb"},"inLanguage":"fr-FR","potentialAction":[{"@type":"ReadAction","target":["https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/"]}]},{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/#primaryimage","url":"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-5-ecg-3-scaled.jpeg","contentUrl":"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-5-ecg-3-scaled.jpeg","width":2560,"height":1789},{"@type":"BreadcrumbList","@id":"https:\/\/cardiocases.com\/ecg_case\/trace-5-5-extrasystoles-atriales-initiant-une-arythmie-atriale\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/cardiocases.com\/"},{"@type":"ListItem","position":2,"name":"Trac\u00e9 5.5: Extrasystoles atriales initiant une arythmie atriale"}]},{"@type":"WebSite","@id":"https:\/\/cardiocases.com\/#website","url":"https:\/\/cardiocases.com\/","name":"Cardiocases","description":"Real cardiac device traces, pacemaker & ICD learning \u2014 built by electrophysiologists","publisher":{"@id":"https:\/\/cardiocases.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/cardiocases.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"fr-FR"},{"@type":"Organization","@id":"https:\/\/cardiocases.com\/#organization","name":"Cardiocases","url":"https:\/\/cardiocases.com\/","logo":{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/cardiocases.com\/#\/schema\/logo\/image\/","url":"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/07\/cardiocases_logo.png","contentUrl":"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/07\/cardiocases_logo.png","width":1755,"height":499,"caption":"Cardiocases"},"image":{"@id":"https:\/\/cardiocases.com\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.linkedin.com\/company\/cardiocases\/"]}]}},"_links":{"self":[{"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/ecg_case\/10154","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/ecg_case"}],"about":[{"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/types\/ecg_case"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/media\/10153"}],"wp:attachment":[{"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/media?parent=10154"}],"wp:term":[{"taxonomy":"ecg_case_type","embeddable":true,"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/ecg_case_type?post=10154"},{"taxonomy":"language_ecgcase","embeddable":true,"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/language_ecgcase?post=10154"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}