{"id":10170,"date":"2026-04-02T19:50:53","date_gmt":"2026-04-02T19:50:53","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10170"},"modified":"2026-07-01T12:21:04","modified_gmt":"2026-07-01T12:21:04","slug":"trace-6-3-fibrillation-auriculaire","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-3-fibrillation-auriculaire\/","title":{"rendered":"Trac\u00e9 6.3: Fibrillation auriculaire"},"content":{"rendered":"","protected":false},"featured_media":9725,"template":"","ecg_case_type":[255],"language_ecgcase":[259],"class_list":["post-10170","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-atrial-fibrillation-atrial-flutter-atrial-tachycardia","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 6.3: Fibrillation auriculaire","patient_description":"Homme de 65 ans sans ant\u00e9c\u00e9dent particulier; consultation pour palpitations depuis quelques jours","quiz_question":"Quelle(s) anomalie(s) retrouve(nt)-on sur ce trac\u00e9?","quiz_answer_1":"une dysfonction sinusale","quiz_answer_2":"une fibrillation auriculaire","quiz_answer_3":"un flutter originaire de l\u2019oreillette gauche","quiz_answer_4":"un flutter originaire de l\u2019oreillette droite","quiz_answer_5":"une tachycardie atriale","correct_answer":["B"],"ecg_image":9725,"ecg_description":"Aspect caract\u00e9ristique de fibrillation auriculaire; tachycardie irr\u00e9guli\u00e8re \u00e0 QRS fins; activit\u00e9 atriale rapide, anarchique avec tr\u00e9mulation de la ligne de base; activit\u00e9 atriale bien identifiable durant les diastoles longues (intervalle RR long);","ecg_info_box":"Lors d\u2019un \u00e9pisode de fibrillation auriculaire, l\u2019\u00e9lectrocardiogramme montre typiquement une activit\u00e9 atriale rapide, irr\u00e9guli\u00e8re et anarchique et des QRS fins, rapides et irr\u00e9guliers.","commentary_ecg":"La fibrillation auriculaire constitue le trouble du rythme le plus fr\u00e9quemment observ\u00e9 dans la pratique cardiologique quotidienne et correspond \u00e0 une d\u00e9sorganisation compl\u00e8te de l\u2019activit\u00e9 \u00e9lectrique des oreillettes conduisant \u00e0 la perte de la systole atriale.\r\n\r\nLors d\u2019un \u00e9pisode de fibrillation auriculaire, l\u2019\u00e9lectrocardiogramme montre typiquement: 1) une activit\u00e9 atriale rapide (entre 350 et 600 bpm), irr\u00e9guli\u00e8re et anarchique; les ondes auriculaires sont difficilement analysables et r\u00e9alisent des ondulations continues et permanentes de la ligne de base; 2) les complexes QRS sont le plus souvent fins, irr\u00e9guliers (justifiant l\u2019appellation d\u2019arythmie compl\u00e8te par fibrillation auriculaire) avec une fr\u00e9quence augment\u00e9e, sup\u00e9rieure \u00e0 100 bpm mais bien inf\u00e9rieure \u00e0 la fr\u00e9quence atriale. Les cycles RR sont de dur\u00e9e in\u00e9gale ne paraissant ob\u00e9ir \u00e0 aucune r\u00e8gle ou p\u00e9riodicit\u00e9. Cette irr\u00e9gularit\u00e9 tr\u00e8s \u00e9vocatrice du diagnostic de fibrillation auriculaire est secondaire au bombardement incessant du n\u0153ud auriculo-ventriculaire par les influx atriaux.\r\n\r\nIl existe un certain nombre de diff\u00e9rences dans l\u2019aspect \u00e9lectrocardiographique en fonction des caract\u00e9ristiques des patients. L\u2019activit\u00e9 atriale peut \u00eatre d\u2019amplitude variable. Elle est g\u00e9n\u00e9ralement bien volt\u00e9e chez les patients avec valvulopathie mitrale, cardiopathie cong\u00e9nitale ou avec hypertrophie de la paroi (FA \u00e0 large maille). L\u2019amplitude est en moyenne plus importante dans les d\u00e9rivations proches de l\u2019oreillette droite (pr\u00e9cordiales droites, V1-V3). A l\u2019inverse, l\u2019activit\u00e9 atriale peut \u00eatre parfois tr\u00e8s difficile \u00e0 discerner du fait d\u2019une amplitude tr\u00e8s r\u00e9duite (FA \u00e0 petites mailles), le diagnostic \u00e9tant alors sugg\u00e9r\u00e9 par des signes indirects: absence d\u2019ondes P sinusales et irr\u00e9gularit\u00e9 des ventricules. Cela traduit souvent l\u2019existence d\u2019une FA permanente ancienne. Le terme de fibrillo-flutter est impropre et est utilis\u00e9 \u00e0 tort devant une activit\u00e9 atriale volt\u00e9e et paraissant \u201crelativement organis\u00e9e\u201d (le plus souvent en V1). Par d\u00e9finition, l\u2019aspect de flutter correspond \u00e0 une activit\u00e9 parfaitement r\u00e9guli\u00e8re, une activit\u00e9 atriale \u201cl\u00e9g\u00e8rement irr\u00e9guli\u00e8re\u201d devant conduire au diagnostic de fibrillation atriale.\r\n\r\nLa fr\u00e9quence ventriculaire peut \u00eatre r\u00e9guli\u00e8re et lente si un trouble de conduction atrio-ventriculaire est associ\u00e9; on parle alors de brady-arythmie. Quand le rythme ventriculaire est parfaitement r\u00e9gulier, cela sugg\u00e8re l\u2019existence d\u2019un bloc auriculo- ventriculaire complet avec \u00e9chappement le plus souvent jonctionnel. A l\u2019oppos\u00e9, quand la conduction est excellente, les ventricules peuvent \u00eatre tr\u00e8s rapides (> 170 bpm) avec souvent un aspect relativement r\u00e9gulier. La fr\u00e9quence ventriculaire peut \u00eatre tr\u00e8s \u00e9lev\u00e9e (> 250 bpm) et compromettre le pronostic vital, quand le filtre nodal n\u2019op\u00e8re pas chez un patient avec voie accessoire tr\u00e8s perm\u00e9able.\r\n\r\nEtant donn\u00e9 l\u2019origine supra-ventriculaire de l\u2019arythmie, la morphologie des complexes QRS est g\u00e9n\u00e9ralement identique \u00e0 celle des complexes QRS en rythme sinusal. Les complexes QRS sont donc g\u00e9n\u00e9ralement fins. La survenue de QRS larges peut survenir dans 3 circonstances : 1) chez un patient avec bloc de branche l\u00e9sionnel 2) un \u00e9largissement intermittent du QRS peut correspondre \u00e0 une aberration de conduction survenant \u00e0 la suite d\u2019intervalles RR tr\u00e8s courts 3) chez les patients avec pr\u00e9-excitation ventriculaire.\r\n\r\nL\u2019\u00e9lectrocardiogramme apr\u00e8s retour sinusal montre chez ce patient la pr\u00e9sence d\u2019une extrasystole atriale tr\u00e8s pr\u00e9coce dans l\u2019onde T qui constitue fr\u00e9quemment la g\u00e2chette d\u00e9clenchant la survenue d\u2019un \u00e9pisode d\u2019arythmie atriale.","ecg_info_post_answer":"\"\"\r\n\r\n \r\n\r\n \r\n\r\n\"\"\r\n\r\nDescription trac\u00e9<\/strong>\r\n\r\n\u00c9lectrocardiogramme enregistr\u00e9 apr\u00e8s un retour spontan\u00e9 en rythme sinusal; onde P \u00e9largie et bifide en DI, DII, V3, V4 avec composante \u00e9largie en V1: probable hypertrophie auriculaire gauche; extrasystole atriale pr\u00e9coce dans l\u2019onde T (P\/T) suivie d\u2019un QRS avec aberration de conduction;"},"yoast_head":"\nTrac\u00e9 6.3: Fibrillation auriculaire - 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