{"id":10172,"date":"2026-04-02T19:57:30","date_gmt":"2026-04-02T19:57:30","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10172"},"modified":"2026-04-02T19:57:31","modified_gmt":"2026-04-02T19:57:31","slug":"trace-6-4-hypertrophie-auriculaire-gauche-et-fibrillation-auriculaire","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-4-hypertrophie-auriculaire-gauche-et-fibrillation-auriculaire\/","title":{"rendered":"Trac\u00e9 6.4: Hypertrophie auriculaire gauche et fibrillation auriculaire"},"content":{"rendered":"","protected":false},"featured_media":10442,"template":"","ecg_case_type":[255],"language_ecgcase":[259],"class_list":["post-10172","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 6.4: Hypertrophie auriculaire gauche et fibrillation auriculaire","patient_description":"Homme de 79 ans avec hypertension art\u00e9rielle trait\u00e9e; consultation pour palpitations depuis quelques jours","quiz_question":"Quelle(s) anomalie(s) retrouve(nt)-on sur ce trac\u00e9?","quiz_answer_1":"un bloc de branche droit complet","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":"un bloc de branche gauche complet","correct_answer":["A","B"],"ecg_image":10442,"ecg_description":"Aspect caract\u00e9ristique de fibrillation auriculaire; activit\u00e9 atriale rapide, anarchique avec tr\u00e9mulation de la ligne de base; QRS irr\u00e9guliers avec QRS larges et aspect typique de bloc de branche droit complet (QRS > 120 ms, aspect rsR\u2019 en V1 avec retard majeur de la d\u00e9flexion intrins\u00e9co\u00efde, onde S large en V6 et DI); \r\n","ecg_info_box":"l\u2019ECG sinusal chez les patients pr\u00e9sentant des \u00e9pisodes d\u2019arythmie atriale peut mettre en \u00e9vidence diff\u00e9rents \u00e9l\u00e9ments: 1) des extrasystoles atriales pr\u00e9coces (ph\u00e9nom\u00e8ne P\/T) servant de g\u00e2chette \u00e0 l\u2019induction de l\u2019arythmie 2) une \u201chypertrophie\u201d auriculaire gauche t\u00e9moin d\u2019un substrat atrial favorable 3) un aspect du complexe QRS en faveur de l\u2019existence d\u2019une cardiopathie (s\u00e9quelle d\u2019infarctus, hypertrophie ventriculaire gauche ...)","commentary_ecg":"Nous avons vu pr\u00e9c\u00e9demment que le d\u00e9clenchement d\u2019une fibrillation auriculaire n\u00e9cessite une g\u00e2chette (le plus souvent une extrasystole atriale pr\u00e9coce provenant des veines pulmonaires). Ce trac\u00e9 montre \u00e9galement que le risque est accru chez les patients pr\u00e9sentant un substrat favorable. L\u2019aspect de l\u2019onde P en rythme sinusal est chez ce patient \u00e9vocateur d\u2019une activation auriculaire anormale et perturb\u00e9e avec un aspect typique \u00ab d\u2019hypertrophie auriculaire gauche \u00bb. L\u2019\u00e9lectrocardiogramme ne permet pas de diff\u00e9rencier une hypertrophie de l\u2019oreillette, d\u2019un trouble de la conduction \u00e0 l\u2018int\u00e9rieur de l\u2019oreillette ou d\u2019une dilatation de l\u2019oreillette. En effet, si le massif auriculaire est dilat\u00e9, l\u2019onde P s\u2019\u00e9largit du fait de l\u2019augmentation de la dur\u00e9e de la d\u00e9polarisation en rapport avec la plus grande distance que l\u2019onde d\u2019activation doit parcourir. Le terme hypertrophie auriculaire \u00e9lectrocardiographique peut donc correspondre \u00e0 un v\u00e9ritable \u00e9paississement pari\u00e9tal auriculaire, \u00e0 une dilatation de la cavit\u00e9, \u00e0 un trouble de conduction intra-atrial marqu\u00e9 ou \u00e0 une association de ces diff\u00e9rents \u00e9l\u00e9ments. \r\n\r\nDans l\u2019hypertrophie auriculaire gauche, la composante auriculaire gauche de l\u2019onde P est augment\u00e9e en voltage et en dur\u00e9e. La prolongation de l\u2019activation de l\u2019oreillette gauche entraine un allongement de la dur\u00e9e de l\u2019onde P au del\u00e0 du seuil pathologique de 110 ms. \r\n\r\nLa pr\u00e9dominance des vecteurs auriculaires gauches tend \u00e0 d\u00e9placer le vecteur d\u2019activation vers la gauche et vers l\u2019arri\u00e8re. L\u2019axe \u00e9lectrique de l\u2019onde P dans le plan frontal peut \u00eatre d\u00e9vi\u00e9 vers la gauche entre 0 et 30\u00b0 avec une onde P large et ample en DI et moins volt\u00e9e ou diphasique en DII et DIII. Dans ces m\u00eames d\u00e9rivations, l\u2019onde P est souvent de morphologie anormale, crochet\u00e9e, bifide ou emp\u00e2t\u00e9e. En effet, la morphologie de l\u2019onde P est modifi\u00e9e par une individualisation de la composante auriculaire gauche tardive entrainant un aspect bifide \u00e0 double sommet, le second un peu plus \u00e9lev\u00e9 que le premier surtout visualisable DI et aVL moins souvent en DII. \r\n\r\nDans le plan horizontal, les forces de l\u2019onde P sont habituellement orient\u00e9es \u00e0 gauche et en arri\u00e8re. L\u2019onde P en V1 peut \u00eatre de grande dimension avec un aspect diphasique. La surface de la composante terminale n\u00e9gative d\u00e9passe celle de la composante initiale positive. On retrouve fr\u00e9quemment une onde P bifide dans les d\u00e9rivations pr\u00e9cordiales de V3 \u00e0 V6. \r\n\r\nLes principales causes d\u2019hypertrophie auriculaire gauche sont le r\u00e9tr\u00e9cissement mitral, l\u2019insuffisance mitrale et les pathologies avec augmentation de pression du ventricule gauche (r\u00e9tr\u00e9cissement aortique, insuffisance aortique, hypertension art\u00e9rielle \u2026) \r\n\r\n","ecg_info_post_answer":"\"\"\r\n\r\nDescription trac\u00e9<\/strong>\r\n\r\nECG enregistr\u00e9 apr\u00e8s r\u00e9alisation d\u2019un choc \u00e9lectrique programm\u00e9; hypertrophie auriculaire gauche avec onde P de dur\u00e9e allong\u00e9e (>120 ms), bifide en DI, DII et aVL; bloc de branche droit identique \u00e0 celui en tachycardie;\r\n\r\n \r\n\r\n\"\"\r\n\r\n "},"yoast_head":"\nTrac\u00e9 6.4: Hypertrophie auriculaire gauche et fibrillation auriculaire - 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-6-4-hypertrophie-auriculaire-gauche-et-fibrillation-auriculaire\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 6.4: Hypertrophie auriculaire gauche et fibrillation auriculaire - 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