{"id":10156,"date":"2026-04-02T19:38:46","date_gmt":"2026-04-02T19:38:46","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10156"},"modified":"2026-04-09T09:53:20","modified_gmt":"2026-04-09T09:53:20","slug":"trace-5-6-extrasystoles-ventriculaires","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-5-6-extrasystoles-ventriculaires\/","title":{"rendered":"Trac\u00e9 5.6: Extrasystoles ventriculaires"},"content":{"rendered":"","protected":false},"featured_media":10155,"template":"","ecg_case_type":[254],"language_ecgcase":[259],"class_list":["post-10156","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-extrasystoles","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 5.6: Extrasystoles ventriculaires","patient_description":"Homme de 64 ans avec ant\u00e9c\u00e9dent d\u2019infarctus ant\u00e9rieur \u00e9tendu ancien; fraction d\u2019\u00e9jection ventriculaire gauche alt\u00e9r\u00e9e (38%); ECG de contr\u00f4le","quiz_question":"Sur cet ECG, on retrouve:","quiz_answer_1":"des signes d\u2019hypertrophie auriculaire gauche","quiz_answer_2":"des signes de possible s\u00e9quelle d\u2019infarctus ant\u00e9rieur","quiz_answer_3":"des extrasystoles atriales avec aberration de conduction","quiz_answer_4":"des extrasystoles ventriculaires","quiz_answer_5":"des extrasystoles jonctionnelles","correct_answer":["A","B","D"],"ecg_image":10155,"ecg_description":"Rythme sinusal (onde P positive en DI, DII et n\u00e9gative en aVR); hypertrophie auriculaire gauche (onde P large, aspect bifide et fragment\u00e9 en DII, DIII, aVF, V5, V6); PR normal; QRS fin avec s\u00e9quelle de n\u00e9crose ant\u00e9rieure \u00e9tendue (onde q en DI, aVL, V6 et rabotage des ondes R en V1-V4);\r\nExtrasystoles ventriculaires provenant du ventricule gauche: activit\u00e9 ventriculaire pr\u00e9matur\u00e9e (en fin de l\u2019onde T pr\u00e9c\u00e9dente), \u00e0 QRS large (QRS > 160 ms), avec retard droit (QRS positif en V1 et n\u00e9gatif en V6), axe hyper-droit (QRS n\u00e9gatif en DI et dans le territoire inf\u00e9rieur) sugg\u00e9rant une origine ventriculaire gauche, aspect fragment\u00e9 (sugg\u00e9rant l\u2019existence d\u2019une cardiopathie sous-jacente); pr\u00e9sence d\u2019une activit\u00e9 atriale dans l\u2019onde T suivant l\u2019extrasystole probablement d\u2019origine sinusale et non pas r\u00e9trograde (morphologie identique \u00e0 l\u2019activit\u00e9 sinusale, positive en DI, DII et n\u00e9gative en avR, avec un cycle PP restant fixe);","ecg_info_box":"La recherche d\u2019une cardiopathie causale constitue le temps essentiel de la prise en charge des patients pr\u00e9sentant des extrasystoles ventriculaires. L\u2019analyse de l\u2019aspect des complexes QRS d\u2019origine sinusale permet d\u2019\u00e9voquer l\u2019existence d\u2019une s\u00e9quelle de n\u00e9crose isch\u00e9mique, d\u2019une hypertrophie ventriculaire gauche ou droite, de signes de dysplasie arythmog\u00e8ne du ventricule droit ...","commentary_ecg":"Une extrasystole ventriculaire correspond \u00e0 une excitation pr\u00e9matur\u00e9e issue du myocarde ventriculaire indiff\u00e9renci\u00e9 ou du tissu de conduction ventriculaire \u00e0 partir d\u2019un point situ\u00e9 en de\u00e7\u00e0 de la bifurcation des branches du faisceau de His. La pr\u00e9valence des extrasystoles ventriculaires est de 3% environ lors de la r\u00e9alisation d\u2019un ECG simple alors qu\u2019elle peut atteindre 50% chez des sujets sains en cas d\u2019enregistrement continu sur plusieurs jours. La prise en charge d\u2019une extrasystolie ventriculaire constitue un motif de consultation fr\u00e9quent, le contexte de d\u00e9couverte \u00e9tant tr\u00e8s vari\u00e9 et allant de l\u2019examen de d\u00e9pistage lors de la r\u00e9alisation d\u2019un ECG chez un patient asymptomatique dans le cadre d\u2019un bilan pour certificat d\u2019aptitude au sport, d\u2019un bilan de palpitations, de syncope ou de mort subite r\u00e9cup\u00e9r\u00e9e. \r\n\r\nSur l\u2019\u00e9lectrocardiogramme, une extrasystole ventriculaire se caract\u00e9rise par l\u2019existence d\u2019un QRS pr\u00e9matur\u00e9, ectopique, \u00e0 QRS large (> 120 ms), sans association avec une activit\u00e9 atriale pr\u00e9c\u00e9dente. Les extrasystoles ventriculaires doivent plus \u00eatre consid\u00e9r\u00e9es comme un marqueur de risque qui doit orienter vers la recherche d\u2019une cardiopathie et non comme un facteur de risque ind\u00e9pendant sur lequel il faut agir. La recherche d\u2019une cardiopathie causale est donc un temps essentiel de la prise en charge.\r\n\r\nChez ce patient: 1) l\u2019analyse du QRS conduit sur activit\u00e9 sinusale est tr\u00e8s en faveur de l\u2019existence d\u2019une cardiopathie isch\u00e9mique. On retrouve en effet, des signes d\u2019hypertrophie auriculaire gauche mais \u00e9galement des signes de s\u00e9quelle de n\u00e9crose ant\u00e9rieure confirm\u00e9s par l\u2019anamn\u00e8se et l\u2019analyse des ant\u00e9c\u00e9dents du patient. 2) la morphologie des extrasystoles est \u00e9galement en faveur de l\u2019existence d\u2019une cardiopathie. La largeur des complexes QRS ectopiques est importante et d\u00e9passe les 180 ms ce qui est \u00e9vocateur d\u2019une cardiopathie, les extrasystoles b\u00e9nignes survenant sur coeur sain \u00e9tant g\u00e9n\u00e9ralement plus fines (de l\u2019ordre de 140 ms). Les extrasystoles ont un aspect crochet\u00e9, polyphasique et une amplitude relativement faible, autant d\u2019arguments en d\u00e9faveur d\u2019un caract\u00e8re b\u00e9nin. La fragmentation des extrasystoles est consid\u00e9r\u00e9 comme un facteur p\u00e9joratif car traduisant une propagation de l\u2019influx \u00e9lectrique \u00e0 travers un myocarde ventriculaire aux propri\u00e9t\u00e9s de conduction alt\u00e9r\u00e9es, dans un myocarde cicatriciel ou fibros\u00e9. Chez les patients avec myocardiopathie isch\u00e9mique, le retard et l\u2019axe des extrasystoles sont souvent dict\u00e9s par la localisation de la s\u00e9quelle de n\u00e9crose puisque ces extrasystoles sont soit le reflet d\u2019une activit\u00e9 normale de cellules au fonctionnement alt\u00e9r\u00e9 par l\u2019isch\u00e9mie, soit le r\u00e9sultat d\u2019une r\u00e9entr\u00e9e autour de circuits \u00e0 propagation lente de l\u2019influx \u00e9lectrique dans les zones cicatricielles.","ecg_info_post_answer":"<img class=\"alignnone wp-image-10320 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-227-1024x744.png\" alt=\"\" width=\"800\" height=\"581\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 5.6: Extrasystoles ventriculaires - 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-5-6-extrasystoles-ventriculaires\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 5.6: Extrasystoles ventriculaires - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-5-6-extrasystoles-ventriculaires\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-09T09:53:20+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-6-ecg-2-scaled-e1775158573838.png\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1794\" \/>\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-5-6-extrasystoles-ventriculaires\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-6-extrasystoles-ventriculaires\/\",\"name\":\"Trac\u00e9 5.6: Extrasystoles ventriculaires - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-6-extrasystoles-ventriculaires\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-6-extrasystoles-ventriculaires\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-6-ecg-2-scaled-e1775158573838.png\",\"datePublished\":\"2026-04-02T19:38:46+00:00\",\"dateModified\":\"2026-04-09T09:53:20+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-6-extrasystoles-ventriculaires\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-5-6-extrasystoles-ventriculaires\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-6-extrasystoles-ventriculaires\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-6-ecg-2-scaled-e1775158573838.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-6-ecg-2-scaled-e1775158573838.png\",\"width\":2560,\"height\":1794},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-6-extrasystoles-ventriculaires\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 5.6: Extrasystoles ventriculaires\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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