{"id":10158,"date":"2026-04-02T19:40:01","date_gmt":"2026-04-02T19:40:01","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10158"},"modified":"2026-04-02T19:40:02","modified_gmt":"2026-04-02T19:40:02","slug":"trace-5-7-bigeminisme-ventriculaire","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-5-7-bigeminisme-ventriculaire\/","title":{"rendered":"Trac\u00e9 5.7: Big\u00e9minisme ventriculaire"},"content":{"rendered":"","protected":false},"featured_media":10157,"template":"","ecg_case_type":[254],"language_ecgcase":[259],"class_list":["post-10158","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-extrasystoles","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 5.7: Big\u00e9minisme ventriculaire","patient_description":"Homme de 57 ans asymptomatique, sans ant\u00e9c\u00e9dent, adress\u00e9 par son m\u00e9decin traitant \u00e0 son cardiologue, pour bradycardie diagnostiqu\u00e9e au pouls; r\u00e9alisation d\u2019un \u00e9lectrocardio\u00ad gramme dans ce cadre","quiz_question":"Sur cet ECG, on retrouve:","quiz_answer_1":"un bloc de branche droit","quiz_answer_2":"des signes de possible s\u00e9quelle d\u2019infarctus inf\u00e9rieur","quiz_answer_3":"un big\u00e9minisme ventriculaire","quiz_answer_4":"des doublets ventriculaires","quiz_answer_5":"un trig\u00e9minisme ventriculaire","correct_answer":["A","C"],"ecg_image":10157,"ecg_description":"Alternance entre 2 complexes QRS 1) complexe d\u2019origine sinusale (onde P positive en DI, DII, V5, V6 et n\u00e9gative en aVR) avec intervalle PR normal (120 ms); QRS large avec aspect de bloc de branche droit 2) extrasystole ventriculaire bien volt\u00e9e, non fragment\u00e9e, retard gauche; il s\u2019agit donc d\u2019un big\u00e9minisme ventriculaire avec alternance entre un QRS conduit et une extrasysole; ","ecg_info_box":"La prise de pouls chez un patient pr\u00e9sentant des extrasystoles peut donner une fausse impression de bradycardie (bradysphygmie) ou retrouver une irr\u00e9gularit\u00e9 dans le rythme et l\u2019amplitude des battements ressentis (amplitude augment\u00e9e sur le cycle suivant la pause post-extrasystolique en raison d\u2019un temps diastolique augment\u00e9).","commentary_ecg":"Les patients pr\u00e9sentant des extrasystoles ventriculaires peuvent \u00eatre parfaitement asymptomatiques, le diagnostic se faisant \u00e0 la prise de pouls avec mise en \u00e9vidence d\u2019une irr\u00e9gularit\u00e9 et de battements pr\u00e9matur\u00e9s. Comme chez ce patient, la prise de pouls peut conduire au diagnostic de bradysphygmie qui correspond \u00e0 un ralentissement du pouls en raison de l\u2019inefficacit\u00e9 h\u00e9modynamique des extrasystoles, le pouls restant r\u00e9gulier si l\u2019extrasystolie est big\u00e9min\u00e9e. Cette bradycardie effective peut entrainer une symptomatologie type asth\u00e9nie ou dyspn\u00e9e d\u2019effort. \r\n\r\nLe nombre d\u2019extrasystoles sur une journ\u00e9e ne constitue pas un facteur pronostic majeur. La charge en extrasystoles est en revanche d\u00e9terminante concernant l\u2019\u00e9ventuel retentissement sur la fonction cardiaque. Le big\u00e9minisme observ\u00e9 chez ce patient peut, si il se maintient, \u00eatre responsable du d\u00e9veloppement d\u2019une v\u00e9ritable cardiopathie rythmique. La caract\u00e9risation de l\u2019extrasystolie peut donc \u00eatre compl\u00e9t\u00e9e par la r\u00e9alisation d\u2019un Holter-ECG des 24 heures qui permet une \u00e9valuation quantitative avec mesure de la charge en extrasystoles sur 24 heures, mais \u00e9galement qualitative avec le nombre de morphologies diff\u00e9rentes (extrasystoles monomorphes ou polymorphes), le couplage, l\u2019existence de formes r\u00e9p\u00e9titives (pr\u00e9sence de doublets, triplets, et\/ou de salves), le lien avec la fr\u00e9quence cardiaque (m\u00e9canisme cat\u00e9cholergique, vagal ou ind\u00e9termin\u00e9), l\u2019alternance jour-nuit (distribution nocturne et diurne). Plus que le nombre absolu d\u2019extrasystoles, il semble que la pr\u00e9sence d\u2019activit\u00e9s r\u00e9p\u00e9titives \u00e0 couplage tr\u00e8s courts, permettent d\u2019identifier les patients les plus \u00e0 risque. 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