{"id":10162,"date":"2026-04-02T19:42:59","date_gmt":"2026-04-02T19:42:59","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10162"},"modified":"2026-04-09T09:54:19","modified_gmt":"2026-04-09T09:54:19","slug":"trace-5-9-trigeminisme-ventriculaire-et-esv-benignes","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-5-9-trigeminisme-ventriculaire-et-esv-benignes\/","title":{"rendered":"Trac\u00e9 5.9: Trig\u00e9minisme ventriculaire et esv b\u00e9nignes"},"content":{"rendered":"","protected":false},"featured_media":10161,"template":"","ecg_case_type":[254],"language_ecgcase":[259],"class_list":["post-10162","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-extrasystoles","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 5.9: Trig\u00e9minisme ventriculaire et esv b\u00e9nignes","patient_description":"Femme de 37 ans sans ant\u00e9c\u00e9dent; r\u00e9alisation d\u2019un \u00e9lectrocardiogramme dans le cadre de palpitations","quiz_question":"Sur cet ECG, on retrouve","quiz_answer_1":"des signes d\u2019hypertrophie ventriculaire gauche","quiz_answer_2":"un big\u00e9minisme ventriculaire","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":["C"],"ecg_image":10161,"ecg_description":"Rythme sinusal (onde P positive en DI, DII et n\u00e9gative en aVR); PR normal (190 ms); QRS fin avec h\u00e9mibloc ant\u00e9rieur gauche (axe gauche avec rabotage des ondes R en VI-V4); extrasystoles ventriculaires trig\u00e9min\u00e9es avec alternance entre deux QRS conduits et une extrasysole; probable extrasystole infundibulaire ventriculaire droite b\u00e9nigne: extrasystole relativement fine, non fragment\u00e9e, avec retard gauche (n\u00e9gatif en V1 et positif en V6), transition en V4 et aspect de \u201cfl\u00e8che\u201d infundibulaire (voltage important avec positivit\u00e9 dans les d\u00e9rivations inf\u00e9rieures); conduction atriale r\u00e9trograde (ondes P\u2019 n\u00e9gatives en inf\u00e9rieur) avec pause sinusale post-extrasystole","ecg_info_box":"-","commentary_ecg":"L\u2019aspect retrouv\u00e9 sur cet \u00e9lectrocardiogramme correspond \u00e0 des extrasystoles ventriculaires droites b\u00e9nignes. Elles surviennent chez des patients sans cardiopathie sous-jacente, sans anomalie m\u00e9tabolique et en l\u2019absence d\u2019un terrain de pr\u00e9dilection sp\u00e9cifique. On retrouve des extrasystoles ventriculaires monomorphes, avec un aspect de retard gauche et un axe vertical descendant, provenant de la chambre de chasse du ventricule droit. Elles sont typiquement amples, non crochet\u00e9es et peu \u00e9largies, \u00e0 couplage long et fixe. Elles sont parfois tr\u00e8s nombreuses, voire big\u00e9min\u00e9es. Pour sugg\u00e9rer le caract\u00e8re b\u00e9nin, le reste de l\u2019\u00e9lectrocardiogramme doit \u00e9galement \u00eatre dans les limites de la normale.\r\n\r\nTrois examens compl\u00e9mentaires (\u00e9chocardiographie cardiaque, Holter-ECG, \u00e9preuve d\u2019effort) font partie du bilan de premi\u00e8re intention devant la d\u00e9couverte de ce type d\u2019extrasystoles.\r\n\r\nL\u2019apport de l\u2019\u00e9chocardiographie cardiaque est ici important pour \u00e9liminer une pathologie cardiaque sous-jacente. Il faut toutefois garder en m\u00e9moire que le rendement de l\u2019\u00e9chocardiographie est imparfait pour le diagnostic de dysplasie arythmog\u00e8ne d\u00e9butante, le principal diagnostic diff\u00e9rentiel devant des extrasystoles provenant du ventricule droit.\r\n\r\nLe Holter-ECG permet d\u2019\u00e9valuer le degr\u00e9 de polymorphisme, les extrasystoles b\u00e9nignes sur c\u0153ur sain \u00e9tant dans l\u2019immense majorit\u00e9 des cas monomorphes. Si quelques cas ont montr\u00e9 l\u2019existence possible de 2 morphologies diff\u00e9rentes sur c\u0153ur sain, \u00e0 partir de 3 morphologies, l\u2019existence d\u2019une cardiopathie parait certaine. \r\n\r\nL\u2019\u00e9preuve d\u2019effort permet d\u2019\u00e9valuer le comportement des extrasystoles lors d\u2019une stimulation cat\u00e9cholergique. L\u2019effet de l\u2019effort sur les extrasystoles b\u00e9nignes peut \u00eatre variable avec possibilit\u00e9 de diminution ou d\u2019exacerbation pendant l\u2019effort ou en r\u00e9cup\u00e9ration. Une apparition ou une majoration \u00e0 l\u2019effort peut toutefois constituer un crit\u00e8re de mauvais pronostic, et un argument majeur pour l\u2019existence d\u2019une cardiopathie sous jacente (insuffisance coronaire, dysplasie).\r\n\r\nApr\u00e8s cette premi\u00e8re \u00e9tape, en l\u2019absence de certitudes, le bilan peut \u00eatre approfondi avec r\u00e9alisation de tests pharmacologiques ou de mesures de potentiels tardifs ventriculaires. L\u2019IRM cardiaque est aujourd\u2019hui l\u2019examen de r\u00e9f\u00e9rence pour l\u2019analyse du substrat myocardique ventriculaire droit ou ventriculaire gauche.\r\n\r\nChez les sujets avec c\u0153ur \u00ab apparemment \u00bb sain, la d\u00e9couverte d\u2019extrasystoles ventriculaires b\u00e9nignes n\u2019est pas associ\u00e9e \u00e0 une augmentation du risque de mort subite par rapport \u00e0 celui de la population g\u00e9n\u00e9rale. Elles ne justifient donc pas d\u2019un traitement ni de restriction de l\u2019activit\u00e9 physique si le patient est asymptomatique. Les objectifs seront de rassurer le patient et de proposer des r\u00e8gles hygi\u00e9no- di\u00e9t\u00e9tiques simples (diminution des excitants comme le caf\u00e9 et l\u2019alcool). Un traitement m\u00e9dicamenteux ne s\u2019envisage que chez les patients symptomatiques, les patients avec alt\u00e9ration de la fonction ventriculaire gauche due \u00e0 une possible myocardiopathie rythmique ou les patients pr\u00e9sentant des extrasystoles ayant des crit\u00e8res de gravit\u00e9. \r\n\r\nUn traitement par b\u00eatabloquant ou inhibiteur calcique est souvent propos\u00e9 en premi\u00e8re intention. En cas d\u2019\u00e9chec, les inhibiteurs des canaux sodiques (fl\u00e9ca\u00efnide, propaf\u00e9none) sont souvent efficaces et entrainent souvent moins d\u2019effets ind\u00e9sirables que les traitements pr\u00e9c\u00e9dents (fatigue par exemple). On ne peut toutefois les prescrire qu\u2019apr\u00e8s exclusion formelle de toute cardiopathie structurelle. En effet, l\u2019\u00e9tude CAST a montr\u00e9 que chez les patients pr\u00e9sentant une cardiopathie, un traitement par anti- arythmique classe Ic permettait de \u201cnettoyer\u201d le Holter-ECG en diminuant le nombre d\u2019extrasystoles au prix d\u2019un effet paradoxal d\u00e9l\u00e9t\u00e8re d\u2019augmentation de la mortalit\u00e9 dans le groupe trait\u00e9.\r\n\r\nQuand les extrasystoles sont nombreuses, monomorphes et g\u00e9n\u00e8rent des sympt\u00f4mes, l\u2019ablation par radiofr\u00e9quence est int\u00e9ressante car elle peut permettre de traiter d\u00e9finitivement le probl\u00e8me.","ecg_info_post_answer":"\"\""},"yoast_head":"\nTrac\u00e9 5.9: Trig\u00e9minisme ventriculaire et esv b\u00e9nignes - 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-5-9-trigeminisme-ventriculaire-et-esv-benignes\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 5.9: Trig\u00e9minisme ventriculaire et esv b\u00e9nignes - 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