{"id":10181,"date":"2026-04-02T20:29:24","date_gmt":"2026-04-02T20:29:24","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10181"},"modified":"2026-04-09T10:03:37","modified_gmt":"2026-04-09T10:03:37","slug":"trace-6-8-flutter-1-1-sous-flecainide","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-8-flutter-1-1-sous-flecainide\/","title":{"rendered":"Trac\u00e9 6.8: Flutter 1\/1 sous fl\u00e9ca\u00efnide"},"content":{"rendered":"","protected":false},"featured_media":10180,"template":"","ecg_case_type":[255],"language_ecgcase":[259],"class_list":["post-10181","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 6.8: Flutter 1\/1 sous fl\u00e9ca\u00efnide","patient_description":"Femme de 67 ans, hypertendue trait\u00e9e par fl\u00e9ca\u00efnide pour fibrillation auriculaire paroxys\u00ad tique; palpitations avec lipothymie; enregistrement du trac\u00e9 A \u00e0 l\u2019entr\u00e9e","quiz_question":"Quelle(s) est(sont) le(les) diagnostic(s) possible(s) sur cet ECG?","quiz_answer_1":"tachycardie ventriculaire","quiz_answer_2":"fibrillation auriculaire avec bloc de branche gauche","quiz_answer_3":"flutter atrial 1\/1 sous fl\u00e9ca\u00efnide","quiz_answer_4":"torsade de pointe","quiz_answer_5":"r\u00e9entr\u00e9e intranodale avec bloc de branche droit","correct_answer":["A","C"],"ecg_image":10180,"ecg_description":"Tachycardie tr\u00e8s rapide (plus de 200 bpm) \u00e0 QRS large (axe gauche, retard gauche); on ne retrouve pas d\u2019aspect typique d\u2019aberration de conduction (bloc de branche droit ou bloc de branche gauche); l\u2019activation atriale est difficile \u00e0 visualiser; il n\u2019est donc pas possible de diff\u00e9rencier formellement tachycardie ventriculaire et flutter atrial 1\/1 sous fl\u00e9ca\u00efnide;","ecg_info_box":"Une tachycardie \u00e0 QRS large chez un patient b\u00e9n\u00e9ficiant d\u2019un traitement par antiarythmique de classe Ic doit faire \u00e9voquer le diagnostic de flutter 1\/1. L\u2019aspect \u00e9lectrique de ce trouble du rythme est difficile \u00e0 diff\u00e9rencier de celui d\u2019une tachycardie ventriculaire avec des QRS tr\u00e8s larges, de morphologie atypique avec une activit\u00e9 atriale souvent difficile \u00e0 identifier.","commentary_ecg":"-","ecg_info_post_answer":"&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10332 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-281-1024x777.png\" alt=\"\" width=\"800\" height=\"607\" \/>\r\n\r\n&nbsp;\r\n\r\n<strong>Commentaires<\/strong>\r\n\r\nLes propri\u00e9t\u00e9s \u00e9lectrophysiologiques du noeud auriculo-ventriculaire (conduction d\u00e9cr\u00e9mentielle) permettent normalement de filtrer l\u2019activation atriale rapide observ\u00e9e lors d\u2019un flutter commun avec apparition d\u2019un bloc de conduction atrioventriculaire protecteur (2\/1, 3\/1 ...). Chez certains patients toutefois, une conduction 1\/1 aux ventricules des influx atriaux peut engendrer la survenue d\u2019une syncope, d\u2019un collapsus ou d\u2019une mort subite et constitue une urgence vitale.\r\n\r\nLes antiarythmiques de la classe 1C sont fr\u00e9quemment utilis\u00e9s dans le traitement de la fibrillation auriculaire, leur administration n\u2019\u00e9tant pas sans risque. En effet, un flutter \u00e0 conduction 1\/1 peut survenir en l\u2019absence de tout traitement m\u00e9dical mais survient pr\u00e9f\u00e9rentiellement chez les patients trait\u00e9s par fl\u00e9ca\u00efnide, propaf\u00e9none ou plus rarement aujourd\u2019hui par quinidine (concept de flutter quinidinique). Le fl\u00e9ca\u00efnide ou la propaf\u00e9none allongent significativement les vitesses de conduction du tissu atrial et ralentissent donc la cadence atriale du flutter. En parall\u00e8le, les effets sur la prolongation des p\u00e9riodes r\u00e9fractaires du noeud auriculo-ventriculaire sont nulles ou modestes. Il peut m\u00eame exister un effet vagolytique du fl\u00e9ca\u00efnide favorisant une am\u00e9lioration de la conduction auriculo-ventriculaire. En cons\u00e9quence, l\u2019allongement du cycle de r\u00e9entr\u00e9e atriale, le ralentissement de la fr\u00e9quence atriale du flutter sans effet d\u00e9pressif sur la conduction atrioventriculaire peuvent faciliter la conduction au niveau ventriculaire de chaque impulsion atriale (1\/1). La r\u00e9alisation d\u2019un effort (qui s\u2019accompagne d\u2019une r\u00e9duction de la p\u00e9riode r\u00e9fractaire nodale) peut \u00e9galement en favoriser la survenue. Les patients avec PR court (traduisant une bonne conduction auriculo-ventriculaire intrins\u00e8que) sont les patients les plus \u00e0 risque.\r\n\r\nLe diagnostic \u00e9lectrocardiographique est parfois tr\u00e8s difficile mais doit \u00eatre \u00e9voqu\u00e9 chez tous les patients b\u00e9n\u00e9ficiant d\u2019un traitement par antiarythmique de la classe Ic devant une tachycardie \u00e0 QRS fins ou \u00e0 QRS larges. L\u2019activit\u00e9 ventriculaire rapide masque l\u2019activation atriale caract\u00e9ristique du flutter commun. La r\u00e9alisation de manoeuvres vagales permet parfois de bloquer la conduction atrio-ventriculaire et de mettre en \u00e9vidence l\u2019aspect en dents de scie caract\u00e9ristique. Les QRS peuvent \u00eatre \u00e9largis durant la tachycardie rendant difficile le diagnostic diff\u00e9rentiel avec une tachycardie ventriculaire. Chez les patients sous traitement par antiarythmique de la classe Ic, la largeur du QRS d\u00e9pend de la fr\u00e9quence cardiaque. En effet, l\u2019intensit\u00e9 du blocage des canaux sodiques provoqu\u00e9 par ces m\u00e9dicaments est proportionnelle \u00e0 l\u2019accroissement de la fr\u00e9quence. Pour une fr\u00e9quence basse, le blocage est mod\u00e9r\u00e9 et les QRS sont fins. En revanche, pour des fr\u00e9quences ventriculaires d\u00e9passant 200 bpm, il n\u2019est pas rare d\u2019observer des QRS extr\u00eamement larges et de morphologie \u201catypique\u201d. La prise de ce type de m\u00e9dicaments modifie donc compl\u00e8tement l\u2019analyse du trac\u00e9 d\u2019une tachycardie avec impossibilit\u00e9 d\u2019utiliser les crit\u00e8res habituels concernant l\u2019aspect du QRS pour diff\u00e9rencier tachycardies ventriculaires et tachycardies supra-ventriculaires.\r\n\r\nCe type de tachycardie constitue une urgence vitale devant le risque que l\u2019arythmie d\u00e9g\u00e9n\u00e8re en fibrillation ventriculaire. Une instabilit\u00e9 h\u00e9modynamique peut justifier de la r\u00e9alisation d\u2019une cardioversion en urgence sous br\u00e8ve s\u00e9dation pour permettre de r\u00e9tablir le rythme sinusal. Si l\u2019arythmie est bien support\u00e9e, un traitement par b\u00e9tabloquant d\u2019action rapide peut \u00eatre propos\u00e9 pour ralentir la conduction atrioventriculaire.\r\n\r\nCe type de complications illustre les limites et les risques associ\u00e9s \u00e0 la prise d\u2019un traitement antiarythmique de classe Ic en monoth\u00e9rapie et est en faveur de l\u2019association syst\u00e9matique avec un traitement \u00e0 effet dromotropique n\u00e9gatif, permettant de ralentir la conduction atrioventriculaire (b\u00e9tabloquants, inhibiteurs calciques). Certains cas d\u2019inefficacit\u00e9 de cette prise conjointe (Ic + b\u00e9tabloquant) ont toutefois \u00e9t\u00e9 d\u00e9crits possiblement en rapport avec un dosage insuffisant.\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10443 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-6-8-ecg2-1024x729.png\" alt=\"\" width=\"800\" height=\"570\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nCe second trac\u00e9 est enregistr\u00e9 apr\u00e8s l\u2019infusion intraveineuse d\u2019une ampoule de b\u00e9tabloquant\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10333 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-283-1024x646.png\" alt=\"\" width=\"800\" height=\"505\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nApr\u00e8s l\u2019infusion intraveineuse d\u2019une ampoule de b\u00e9tabloquant; la fr\u00e9quence ventriculaire s\u2019est ralentie, les QRS se sont affin\u00e9s (h\u00e9mibloc ant\u00e9rieur gauche); l\u2019existence de diastoles longues (conduction 2\/1 ou 3\/1) permet de mettre en \u00e9vidence un aspect caract\u00e9ristique de flutter atrial commun; le premier trac\u00e9 correspondait donc \u00e0 un flutter atrial conduit en 1\/1 avec \u00e9largissement fr\u00e9quence-d\u00e9pendant de la dur\u00e9e du QRS sous fl\u00e9ca\u00efnide (la fr\u00e9quence ventriculaire sur le premier trac\u00e9 est identique \u00e0 la fr\u00e9quence atriale du flutter);\r\n\r\n&nbsp;\r\n\r\n&nbsp;"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 6.8: Flutter 1\/1 sous fl\u00e9ca\u00efnide - 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-6-8-flutter-1-1-sous-flecainide\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 6.8: Flutter 1\/1 sous fl\u00e9ca\u00efnide - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-8-flutter-1-1-sous-flecainide\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-09T10:03:37+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-8-ecg-2.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1228\" \/>\n\t<meta property=\"og:image:height\" content=\"940\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\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-6-8-flutter-1-1-sous-flecainide\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-8-flutter-1-1-sous-flecainide\/\",\"name\":\"Trac\u00e9 6.8: Flutter 1\/1 sous fl\u00e9ca\u00efnide - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-8-flutter-1-1-sous-flecainide\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-8-flutter-1-1-sous-flecainide\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-8-ecg-2.png\",\"datePublished\":\"2026-04-02T20:29:24+00:00\",\"dateModified\":\"2026-04-09T10:03:37+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-8-flutter-1-1-sous-flecainide\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-6-8-flutter-1-1-sous-flecainide\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-8-flutter-1-1-sous-flecainide\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-8-ecg-2.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-8-ecg-2.png\",\"width\":1228,\"height\":940},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-8-flutter-1-1-sous-flecainide\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 6.8: Flutter 1\/1 sous fl\u00e9ca\u00efnide\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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