{"id":10175,"date":"2026-04-02T20:17:03","date_gmt":"2026-04-02T20:17:03","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10175"},"modified":"2026-04-09T09:58:16","modified_gmt":"2026-04-09T09:58:16","slug":"trace-6-5-flutter-commun","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-5-flutter-commun\/","title":{"rendered":"Trac\u00e9 6.5: Flutter commun"},"content":{"rendered":"","protected":false},"featured_media":10174,"template":"","ecg_case_type":[255],"language_ecgcase":[259],"class_list":["post-10175","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 6.5: Flutter commun","patient_description":"Homme de 78 ans trait\u00e9 par fl\u00e9ca\u00efnide et b\u00e9tabloquant dans le cadre d\u2019\u00e9pisodes de FA par\u00ad oxystique; consultation pour palpitations et asth\u00e9nie ressenties depuis quelques jours","quiz_question":"Sur cet ECG, on retrouve:","quiz_answer_1":"un rythme de base sinusal","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 jonctionnelle","correct_answer":["D"],"ecg_image":10174,"ecg_description":"On retrouve un aspect de flutter commun (circuit antihoraire dans l\u2019oreillette droite isthmo-d\u00e9pendant); l\u2019activit\u00e9 atriale est rapide (270 pm), r\u00e9guli\u00e8re et monomorphe; les d\u00e9rivations inf\u00e9rieures montrent l\u2019aspect typique en dents de scie: la n\u00e9gativit\u00e9 pr\u00e9domine, la pente ascendante est plus abrupte que la phase descendante sans jamais de retour \u00e0 la ligne iso\u00e9lectrique; l\u2019activit\u00e9 atriale est tr\u00e8s peu volt\u00e9e en DI, elle est positive en V1 et n\u00e9gative en V6. La conduction atrio-ventriculaire est principalement de type 4\/1 avec une fr\u00e9quence ventriculaire proche de 75 bpm; les QRS sont fins;","ecg_info_box":"-","commentary_ecg":"Le flutter atrial commun correspond \u00e0 une tachycardie en rapport avec une macro-r\u00e9entr\u00e9e de l\u2019oreillette droite. M\u00eame si son incidence est environ 10 fois moindre que celle de la fibrillation auriculaire, la survenue d\u2019un flutter atrial est relativement fr\u00e9quente surtout chez les patients ob\u00e8ses ou chez les patients pr\u00e9sentant une cardiopathie touchant l\u2019oreillette droite (communication inter-atriale, maladie d\u2019Ebstein, c\u0153ur pulmonaire chronique, incision chirurgicale de l\u2019oreillette droite \u2026). Il est \u00e0 noter que fibrillation atriale et flutter peuvent coexister ou se succ\u00e9der chez un m\u00eame patient. L\u2019ablation de l\u2019isthme cavo-tricuspide permettant un traitement radical et efficace dans une majorit\u00e9 des cas, il est important d\u2019en connaitre les m\u00e9canismes physiopathologiques et les principales caract\u00e9ristiques \u00e9lectrocardiographiques permettant de poser le diagnostic. La majorit\u00e9 des flutters atriaux survenant sur c\u0153ur sain non cicatriciel correspondent \u00e0 des macro-r\u00e9entr\u00e9es de l\u2019oreillette droite d\u00e9pendantes de l\u2019isthme cavo-tricuspidien avec une rotation antihoraire. Le circuit de r\u00e9entr\u00e9e est confin\u00e9 \u00e0 l\u2019oreillette droite avec un front de d\u00e9polarisation descendant dans la paroi lat\u00e9rale et ascendant au niveau du septum. Le circuit est d\u00e9limit\u00e9 en ant\u00e9rieur par la valve tricuspide et en post\u00e9rieur par un certain nombre d\u2019obstacles anatomiques (orifice de la veine cave sup\u00e9rieure et de la veine cave inf\u00e9rieure, anneau d\u2019Eustachi) et par des barri\u00e8res anatomico-fonctionnelles (crista terminalis, r\u00e9gion du sinus venosus). L\u2019activation remonte le long du septum inter-atrial dans sa partie ant\u00e9rieure, se r\u00e9fl\u00e9chit sur le toit de l\u2019oreillette puis descend le long de sa paroi ant\u00e9ro-lat\u00e9rale en avant de la crista terminalis, pour rejoindre la partie basse du septum en passant par un isthme \u00e0 conduction lente d\u00e9limit\u00e9 par l\u2019anneau tricuspide en avant et l\u2019ostium de la veine cave inf\u00e9rieure en arri\u00e8re.\r\n\r\nLe trajet du circuit \u00e9tant remarquablement reproductible d\u2019un patient \u00e0 l\u2019autre, certaines caract\u00e9ristiques \u00e9lectrocardiographiques sont retrouv\u00e9es syst\u00e9matiquement rendant souvent le diagnostic \u00e9vident pour peu que l\u2019activit\u00e9 atriale soit visible. L\u2019analyse de la morphologie des ondes de flutter peut \u00eatre favoris\u00e9e par la r\u00e9alisation d\u2019un massage sino-carotidien qui ne modifie pas le cycle atrial mais ralentit la conduction et supprime la superposition des ventriculogrammes. Le diagnostic de flutter sera donc pos\u00e9 devant la mise en \u00e9vidence d\u2019ondes de flutter remarquablement uniformes pr\u00e9sentant les caract\u00e9ristiques suivantes : \r\n\u2022 La fr\u00e9quence atriale est habituellement comprise entre 250 et 300 bpm. Il existe toutefois une certaine corr\u00e9lation entre le degr\u00e9 de dilatation de l\u2019oreillette droite et le cycle du flutter, le cycle \u00e9tant d\u2019autant plus long (cadence atriale moins rapide) que l\u2019oreillette est dilat\u00e9e. De m\u00eame, les m\u00e9dicaments anti-arythmiques peuvent allonger le cycle et modifier la morphologie des ondes de flutter. A l\u2019oppos\u00e9, la fr\u00e9quence atriale peut \u00eatre plus rapide et atteindre 350 \u00e0 400 bpm en p\u00e9riode n\u00e9o-natale et chez le nourrisson. \r\n\u2022 D\u00e9rivations inf\u00e9rieures (DII, DIII, aVF) : on retrouve dans ces d\u00e9rivations l\u2019aspect typique en dents de scie, en toit d\u2019usine ; les ondes f apparaissent sous l\u2019aspect d\u2019accidents diphasiques avec une n\u00e9gativit\u00e9 pr\u00e9dominante (plus volt\u00e9e et plus large) suivie d\u2019une positivit\u00e9 plus r\u00e9duite avec une pente ascendante plus abrupte que la phase descendante sans jamais de retour \u00e0 la ligne iso\u00e9lectrique. Un aspect de plateau peut \u00eatre observ\u00e9 durant la phase descendante. \r\n\u2022 D\u00e9rivations D1 et aVL : ces d\u00e9rivations sont orient\u00e9es perpendiculairement au vecteur d\u2019activation du flutter et n\u2019inscrivent que des accidents de faible amplitude; l\u2019activit\u00e9 atriale y est donc peu volt\u00e9e. \r\n\u2022 D\u00e9rivations pr\u00e9cordiales droites (V1) : il est fr\u00e9quent d\u2019observer une d\u00e9polarisation atriale \u00e0 2 composantes avec une activit\u00e9 initialement iso\u00e9lectrique suivie d\u2019une onde positive pr\u00e9dominante \u00e0 sommet pointu. \r\n\u2022 D\u00e9rivations pr\u00e9cordiales gauche (V6): la composante positive observ\u00e9e en V1 s\u2019inverse avec les d\u00e9rivations pr\u00e9cordiales et en V6 l\u2019activation \u00e9lectrique est habituellement n\u00e9gative et de faible amplitude. \r\n\u2022 La r\u00e9ponse ventriculaire la plus fr\u00e9quente est de type 2\/1 et la constatation d\u2019une tachycardie \u00e0 150 bpm doit faire \u00e9voquer de principe un flutter atrial. La conduction atrioventriculaire peut \u00eatre alt\u00e9r\u00e9e avec un aspect 3\/1, 4\/1 ou m\u00eame un aspect de bloc auriculo-ventriculaire complet. Un des trac\u00e9s suivants illustre le cas o\u00f9 au contraire la conduction est am\u00e9lior\u00e9e avec un rapport 1\/1. Parfois la conduction est variable. On observe alors une fr\u00e9quence ventriculaire apparemment irr\u00e9guli\u00e8re. L\u2019examen des cycles RR permet toutefois de retrouver des s\u00e9quences r\u00e9p\u00e9titives avec un aspect caract\u00e9ristique de Wenckebach altern\u00e9.\r\n","ecg_info_post_answer":"<img class=\"alignnone wp-image-10329 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-269-1024x665.png\" alt=\"\" width=\"800\" height=\"520\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 6.5: Flutter commun - 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-6-5-flutter-commun\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 6.5: Flutter commun - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-5-flutter-commun\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-09T09:58:16+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-5-ecg-6-scaled-e1775159902436.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1572\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-5-flutter-commun\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-5-flutter-commun\/\",\"name\":\"Trac\u00e9 6.5: Flutter commun - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-5-flutter-commun\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-5-flutter-commun\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-5-ecg-6-scaled-e1775159902436.jpeg\",\"datePublished\":\"2026-04-02T20:17:03+00:00\",\"dateModified\":\"2026-04-09T09:58:16+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-5-flutter-commun\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-6-5-flutter-commun\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-5-flutter-commun\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-5-ecg-6-scaled-e1775159902436.jpeg\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-5-ecg-6-scaled-e1775159902436.jpeg\",\"width\":2560,\"height\":1572},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-5-flutter-commun\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 6.5: Flutter commun\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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