{"id":10184,"date":"2026-04-02T20:52:22","date_gmt":"2026-04-02T20:52:22","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10184"},"modified":"2026-04-09T10:06:14","modified_gmt":"2026-04-09T10:06:14","slug":"trace-6-9-flutter-gauche-sur-coeur-sain","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-9-flutter-gauche-sur-coeur-sain\/","title":{"rendered":"Trac\u00e9 6.9: Flutter gauche sur c\u0153ur sain"},"content":{"rendered":"","protected":false},"featured_media":10183,"template":"","ecg_case_type":[255],"language_ecgcase":[259],"class_list":["post-10184","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 6.9: Flutter gauche sur c\u0153ur sain","patient_description":"Homme de 22 ans sans ant\u00e9c\u00e9dent particulier; hospitalisation aux urgences dans le cadre de palpitations","quiz_question":"Quels sont le(s) diagnostic(s) possibles devant la tachycardie observ\u00e9e sur cet ECG?","quiz_answer_1":"tachycardie atriale","quiz_answer_2":"tachycardie jonctionnelle par r\u00e9entr\u00e9e","quiz_answer_3":"fibrillation atriale","quiz_answer_4":"tachycardie ventriculaire","quiz_answer_5":"FA sur voie accessoire","correct_answer":["A","B"],"ecg_image":10183,"ecg_description":"Ce trac\u00e9 montre une tachycardie r\u00e9guli\u00e8re \u00e0 170 bpm; les QRS sont fins permettant d\u2019\u00e9liminer le diagnostic de tachycardie ventriculaire; \u00e0 noter une alternance entre 2 morphologies de QRS fins (axes identiques mais amplitudes diff\u00e9rentes); l\u2019activit\u00e9 atriale est difficile \u00e0 identifier rendant difficile la diff\u00e9renciation entre une tachycardie atriale et une tachycardie jonctionnelle (r\u00e9entr\u00e9e intranodale ou r\u00e9entr\u00e9e sur voie accessoire);","ecg_info_box":"Un aspect de flutter gauche (r\u00e9entr\u00e9e dans l\u2019oreillette gauche) n\u2019a pas d\u2019aspect caract\u00e9ristique: on retrouve 1) une activit\u00e9 rapide, ectopique, r\u00e9guli\u00e8re et monomorphe 2) une d\u00e9polarisation atriale en V1 le plus souvent positive 3) l\u2019absence d\u2019aspect en dents de scie dans le territoire inf\u00e9rieur. ","commentary_ecg":"-","ecg_info_post_answer":"&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10334 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-287-1024x565.png\" alt=\"\" width=\"800\" height=\"441\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nCe trac\u00e9 montre une tachycardie r\u00e9guli\u00e8re \u00e0 170 bpm; les QRS sont fins permettant d\u2019\u00e9liminer le diagnostic de tachycardie ventriculaire; \u00e0 noter une alternance entre 2 morphologies de QRS fins (axes identiques mais amplitudes diff\u00e9rentes); l\u2019activit\u00e9 atriale est difficile \u00e0 identifier rendant difficile la diff\u00e9renciation entre une tachycardie atriale et une tachycardie jonctionnelle (r\u00e9entr\u00e9e intranodale ou r\u00e9entr\u00e9e sur voie accessoire);\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10445 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-6-9-ecg2-1024x562.png\" alt=\"\" width=\"800\" height=\"439\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nPour faciliter le diagnostic, une ampoule d\u2019Ad\u00e9nosine est administr\u00e9e en flash\r\n\r\n&nbsp;\r\n\r\n<strong>Commentaires<\/strong>\r\n\r\nChez un patient sans ant\u00e9c\u00e9dent ni cardiopathie, la survenue d\u2019un flutter provenant de l\u2019oreillette gauche est tr\u00e8s rare. Elle est un peu plus fr\u00e9quente chez les patients pr\u00e9sentant une valvulopathie mitrale, une hypertension, une insuffisance cardiaque systolique ou diastolique ou chez les patients ayant b\u00e9n\u00e9fici\u00e9 d\u2019une chirurgie cardiaque impliquant l\u2019oreillette gauche. Une proc\u00e9dure d\u2019ablation de fibrillation auriculaire peut \u00e9galement se compliquer de la survenue de ce type d\u2019arythmie. En effet, l\u2019ablation peut \u00eatre extensive dans la cavit\u00e9 atriale avec r\u00e9alisation de lignes de blocs et d\u2019une d\u00e9fragmentation favorisant la survenue de circuits de r\u00e9entr\u00e9e lors de la r\u00e9alisation de lignes incompl\u00e8tes ; les circuits peuvent se situer autour des veines pulmonaires, au niveau septal ou tourner autour de la valve mitrale.\r\n\r\nLes cartographies r\u00e9alis\u00e9es chez les patients ayant pr\u00e9sent\u00e9 ce type d\u2019arythmie ont montr\u00e9 l\u2019existence d\u2019une macro-r\u00e9entr\u00e9e autour de zones \u00e0 conduction lente localis\u00e9es dans l\u2019oreillette gauche. Si l\u2019aspect \u00e9lectrocardiographique typique de flutter commun permet de pr\u00e9dire de fa\u00e7on tr\u00e8s pr\u00e9cise le circuit de r\u00e9entr\u00e9e dans l\u2019oreillette droite et le caract\u00e8re isthmo-d\u00e9pendant, la nature beaucoup plus complexe et les diff\u00e9rentes possibilit\u00e9s de localisation du flutter gauche ne permettent pas une localisation pr\u00e9cise \u00e9lectrocardiographique, la cartographie invasive s\u2019av\u00e9rant indispensable.\r\n\r\nLes manifestations \u00e9lectriques lors d\u2019une tachycardie atriale provenant de l\u2019oreillette gauche d\u00e9pendent non seulement de la s\u00e9quence d\u2019activation auriculaire gauche mais \u00e9galement du passage transseptal et de l\u2019activation auriculaire droite qui en r\u00e9sulte. L\u2019aspect \u00e9lectrocardiographique \u201ctypique\u201d de flutter gauche est donc difficile \u00e0 d\u00e9finir dans la mesure o\u00f9 plusieurs circuits sont possibles mais on retrouve g\u00e9n\u00e9ralement 4 caract\u00e9ristiques plus ou moins sp\u00e9cifiques: 1) l\u2019activit\u00e9 atriale est rapide, ectopique, r\u00e9guli\u00e8re et monomorphe 2) l\u2019onde de d\u00e9polarisation atriale en V1 est le plus souvent positive. Elle peut \u00eatre bien volt\u00e9e comme sur ce trac\u00e9 mais peut \u00eatre moins ample voire iso\u00e9lectrique ; 3) une onde atriale positive en V1 peut correspondre \u00e0 un flutter commun, il s\u2019agit donc d\u2019un signe tr\u00e8s peu sp\u00e9cifique. La troisi\u00e8me caract\u00e9ristique importante pour diagnostiquer ce type d\u2019arythmie est que l\u2019on ne retrouve justement pas l\u2019aspect caract\u00e9ristique de flutter commun atrial droit (aspect en dents de scie dans les d\u00e9rivations inf\u00e9rieures) ; 4) un circuit de r\u00e9entr\u00e9e, \u00e0 la diff\u00e9rence d\u2019un foyer, devrait g\u00e9n\u00e9rer une activit\u00e9 \u00e9lectrique continue. Le fait que l\u2019on observe fr\u00e9quemment un retour \u00e0 la ligne iso\u00e9lectrique entre chaque activit\u00e9 \u00e9lectrique atriale ne sugg\u00e8re toutefois pas un m\u00e9canisme focal \u00e0 l\u2019arythmie et ne remet pas en cause le diagnostic de tachycardie atriale par r\u00e9entr\u00e9e, le circuit g\u00e9n\u00e9rant parfois des signaux de tr\u00e8s faible amplitudes non identifiables sur le trac\u00e9.\r\n\r\nQuand le circuit est situ\u00e9 dans la paroi lat\u00e9rale de l\u2019oreillette gauche, la d\u00e9polarisation atriale est g\u00e9n\u00e9ralement n\u00e9gative dans les d\u00e9rivations DI et aVL. La polarit\u00e9 dans les d\u00e9rivations inf\u00e9rieures d\u00e9pend de la localisation du circuit dans le plan vertical.\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10335 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-289-1024x641.png\" alt=\"\" width=\"800\" height=\"501\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 6.9: Flutter gauche sur c\u0153ur sain - 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-6-9-flutter-gauche-sur-coeur-sain\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 6.9: Flutter gauche sur c\u0153ur sain - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-9-flutter-gauche-sur-coeur-sain\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-09T10:06:14+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-9-ecg-5-scaled.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1810\" \/>\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-6-9-flutter-gauche-sur-coeur-sain\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-9-flutter-gauche-sur-coeur-sain\/\",\"name\":\"Trac\u00e9 6.9: Flutter gauche sur c\u0153ur sain - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-9-flutter-gauche-sur-coeur-sain\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-9-flutter-gauche-sur-coeur-sain\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-9-ecg-5-scaled.jpeg\",\"datePublished\":\"2026-04-02T20:52:22+00:00\",\"dateModified\":\"2026-04-09T10:06:14+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-9-flutter-gauche-sur-coeur-sain\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-6-9-flutter-gauche-sur-coeur-sain\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-9-flutter-gauche-sur-coeur-sain\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-9-ecg-5-scaled.jpeg\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-9-ecg-5-scaled.jpeg\",\"width\":2560,\"height\":1810},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-9-flutter-gauche-sur-coeur-sain\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 6.9: Flutter gauche sur c\u0153ur sain\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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