{"id":10160,"date":"2026-04-02T19:41:30","date_gmt":"2026-04-02T19:41:30","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10160"},"modified":"2026-04-02T19:41:31","modified_gmt":"2026-04-02T19:41:31","slug":"trace-5-8-esv-tres-precoce-et-risque-de-fibrillation-ventriculaire","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-5-8-esv-tres-precoce-et-risque-de-fibrillation-ventriculaire\/","title":{"rendered":"Trac\u00e9 5.8: Esv tr\u00e8s pr\u00e9coce et risque de fibrillation ventriculaire"},"content":{"rendered":"","protected":false},"featured_media":10159,"template":"","ecg_case_type":[254],"language_ecgcase":[259],"class_list":["post-10160","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-extrasystoles","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 5.8: Esv tr\u00e8s pr\u00e9coce et risque de fibrillation ventriculaire","patient_description":"Homme de 39 ans sans ant\u00e9c\u00e9dent particulier; hospitalisation \u00e0 la suite de la survenue d\u20191 \u00e9pisode de syncope traumatisante; enregistrement de ce trac\u00e9","quiz_question":"Sur cet ECG, on retrouve:","quiz_answer_1":"des signes d\u2019hypertrophie ventriculaire gauche","quiz_answer_2":"des extrasystoles ventriculaires \u00e0 couplage court","quiz_answer_3":"des extrasystoles ventriculaires \u00e0 retard gauche","quiz_answer_4":"des extrasystoles ventriculaires \u00e0 retard droit","quiz_answer_5":"des doublets ventriculaires","correct_answer":["B","C"],"ecg_image":10159,"ecg_description":"Rythme sinusal (onde P positive en DI, DII et n\u00e9gative en aVR); QRS fin sans anomalie particuli\u00e8re; extrasystoles ventriculaires tr\u00e8s pr\u00e9coces car survenant dans la phase initiale ascendante de l\u2019onde T; aspect de retard gauche, axe gauche, avec tr\u00e8s probable origine ventriculaire droite car transition tardive (en V4); trig\u00e9minisme ventriculaire (succession de 2 complexes sinusaux et d\u2019une extrasystole); ","ecg_info_box":"Le couplage entre l\u2019extrasystole ventriculaire et le complexe QRS pr\u00e9c\u00e9dent est g\u00e9n\u00e9ralement fixe; quand le couplage est court, l\u2019extrasystole ventriculaire survient sur la branche ascendante de l\u2019onde T ou au sommet de l\u2019onde T, la p\u00e9riode vuln\u00e9rable (certaines cellules ventriculaires sont excitables d\u2019autres sont encore en p\u00e9riode r\u00e9fractaire), avec un risque accru d\u2019induction d\u2019un trouble du rythme ventriculaire polymorphe.","commentary_ecg":"L\u2019existence d\u2019un couplage court entre l\u2019extrasystole ventriculaire et le complexe QRS pr\u00e9c\u00e9dent repr\u00e9sente un indicateur majeur de risque rythmique. Il est d\u2019usage de d\u00e9finir un couplage court en fonction du timing par rapport \u00e0 l\u2019onde T du complexe pr\u00e9c\u00e9dent. L\u2019existence d\u2019une ESV survenant dans la phase ascendante ou au sommet de l\u2019onde T (ph\u00e9nom\u00e8ne R sur T) peut induire une arythmie ventriculaire maligne (torsade de pointe \u00e0 couplage court ou fibrillation ventriculaire) car elle survient durant la phase vuln\u00e9rable. Les m\u00e9canismes de d\u00e9clenchement d\u2019une fibrillation \u00e0 l\u2019\u00e9tage atrial et \u00e0 l\u2019\u00e9tage ventriculaire sont probablement tr\u00e8s proches avec l\u2019interaction entre un facteur d\u00e9clenchant et un substrat. L\u2019importance du r\u00e9seau de Purkinje dans le d\u00e9clenchement de certains \u00e9pisodes de fibrillation ventriculaire a \u00e9t\u00e9 r\u00e9cemment sugg\u00e9r\u00e9e. Les fibres diff\u00e9renci\u00e9es du r\u00e9seau de Purkinje peuvent survivre apr\u00e8s la survenue d\u2019un infarctus transmural et d\u00e9velopper des propri\u00e9t\u00e9s \u00e9lectrophysiologiques arythmog\u00e8nes. Tout comme les veines pulmonaires dans la fibrillation auriculaire focale, le r\u00e9seau de Purkinje peut constituer la source de la g\u00e2chette initiatrice de l\u2019arythmie ventriculaire et pourrait en favoriser l\u2019entretien. L\u2019aspect retrouv\u00e9 sur ce trac\u00e9 correspond \u00e0 une extrasystolie provenant du r\u00e9seau de Purkinje ventriculaire droit distal: les extrasystoles sont tr\u00e8s pr\u00e9coces, relativement larges avec retard gauche. Les extrasystoles provenant du r\u00e9seau de Purkinje ventriculaire droit sont comme chez ce patient le plus souvent monomorphes avec un aspect de retard gauche, axe sup\u00e9rieur et ont une dur\u00e9e moyenne d\u2019environ 140 ms. Celles provenant du r\u00e9seau de Purkinje ventriculaires gauche sont habituellement polymorphes, \u00e9galement tr\u00e8s pr\u00e9coces avec un QRS plus fin caract\u00e9ristique (120 ms en moyenne).\r\n\r\nCe type tr\u00e8s particulier (couplage tr\u00e8s court) d\u2019extrasystole est un marqueur ind\u00e9niable de gravit\u00e9 devant conduire \u00e0 investiguer de fa\u00e7on extensive le patient d\u2019autant qu\u2019il existe une notion de lipothymie\/syncope ou des ant\u00e9c\u00e9dents familiaux de mort subite. L\u2019ablation par radiofr\u00e9quence de ce type d\u2019extrasystoles permet une gu\u00e9rison dans une majorit\u00e9 des cas, le d\u00e9fibrillateur implantable restant indiqu\u00e9 en pr\u00e9vention secondaire.","ecg_info_post_answer":"<img class=\"alignnone wp-image-10322 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-235-1024x527.png\" alt=\"\" width=\"800\" height=\"412\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 5.8: Esv tr\u00e8s pr\u00e9coce et risque de fibrillation 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-5-8-esv-tres-precoce-et-risque-de-fibrillation-ventriculaire\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 5.8: Esv tr\u00e8s pr\u00e9coce et risque de fibrillation ventriculaire - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-5-8-esv-tres-precoce-et-risque-de-fibrillation-ventriculaire\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-02T19:41:31+00:00\" \/>\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-5-8-esv-tres-precoce-et-risque-de-fibrillation-ventriculaire\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-8-esv-tres-precoce-et-risque-de-fibrillation-ventriculaire\/\",\"name\":\"Trac\u00e9 5.8: Esv tr\u00e8s pr\u00e9coce et risque de fibrillation ventriculaire - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-8-esv-tres-precoce-et-risque-de-fibrillation-ventriculaire\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-8-esv-tres-precoce-et-risque-de-fibrillation-ventriculaire\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-8-ecg-4-scaled-e1775158811798.png\",\"datePublished\":\"2026-04-02T19:41:30+00:00\",\"dateModified\":\"2026-04-02T19:41:31+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-8-esv-tres-precoce-et-risque-de-fibrillation-ventriculaire\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-5-8-esv-tres-precoce-et-risque-de-fibrillation-ventriculaire\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-8-esv-tres-precoce-et-risque-de-fibrillation-ventriculaire\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-8-ecg-4-scaled-e1775158811798.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-5-8-ecg-4-scaled-e1775158811798.png\",\"width\":2560,\"height\":1332},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-5-8-esv-tres-precoce-et-risque-de-fibrillation-ventriculaire\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 5.8: Esv tr\u00e8s pr\u00e9coce et risque de fibrillation 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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