{"id":10187,"date":"2026-04-02T20:53:56","date_gmt":"2026-04-02T20:53:56","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10187"},"modified":"2026-04-02T20:53:57","modified_gmt":"2026-04-02T20:53:57","slug":"trace-6-10-flutter-commun-chez-un-patient-avec-cardiopathie-congenitale","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-10-flutter-commun-chez-un-patient-avec-cardiopathie-congenitale\/","title":{"rendered":"Trac\u00e9 6.10: Flutter commun chez un patient avec cardiopathie cong\u00e9nitale"},"content":{"rendered":"","protected":false},"featured_media":10186,"template":"","ecg_case_type":[255],"language_ecgcase":[259],"class_list":["post-10187","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 6.10: Flutter commun chez un patient avec cardiopathie cong\u00e9nitale","patient_description":"Homme de 36 ans pr\u00e9sentant une T\u00e9tralogie de Fallot ; chirurgie r\u00e9paratrice \u00e0 l\u2019\u00e2ge de 3 ans ; reprise chirurgicale avec mise en place d\u2019une bioproth\u00e8se pulmonaire \u00e0 l\u2019\u00e2ge de 21 ans ; hospitalisation pour d\u00e9compensation cardiaque","quiz_question":"Concernant cet ECG, quelle(s) est(sont) la(les) r\u00e9ponse(s) vraie(s)?","quiz_answer_1":"bloc de branche droit","quiz_answer_2":"hypertrophie ventriculaire droite","quiz_answer_3":"flutter atrial","quiz_answer_4":"bloc auriculo-ventriculaire complet","quiz_answer_5":"bloc de branche gauche","correct_answer":["A","B","C"],"ecg_image":10186,"ecg_description":"Bradycardie non sinusale (45 battements\/minute) ; aspect de flutter commun typique ; r\u00e9p\u00e9tition d\u2019ondes F r\u00e9guli\u00e8res et toutes identiques ; aspect en dent de scie dans les d\u00e9rivations inf\u00e9rieures (ligne ascendante rapide, sommet pointu, ligne descendante plus lente, sans retour \u00e0 la ligne iso- \u00e9lectrique); ondes F peu visibles et peu volt\u00e9es en DI, positives en V1 et n\u00e9gatives en V6 ; la dur\u00e9e du cycle auriculaire est de 210 ms (fr\u00e9quence autour de 290 battements\/minute) ; conduction auriculo-ventriculaire variable (1\/8, 1\/6, 1\/5) ; chez ce patient la conduction auriculo-ventriculaire semble donc alt\u00e9r\u00e9e expliquant le rapport entre nombre d\u2019ondes F et nombre de QRS ; bloc de branche droit avec QRS large (175 ms), axe droit, retard marqu\u00e9 de la d\u00e9flexion intrins\u00e9co\u00efde en V1, V2 ;\u2028probable hypertrophie ventriculaire droite.","ecg_info_box":"Les patients avec cardiopathie cong\u00e9nitale ayant b\u00e9n\u00e9fici\u00e9 d\u2019une chirurgie avec atriotomie lat\u00e9rale droite pr\u00e9sentent 2 types d\u2019arythmie atriale organis\u00e9e: flutter commun isthmo-d\u00e9pendant et flutter p\u00e9ri- incisionnel. La dur\u00e9e du cycle de la r\u00e9entr\u00e9e atriale est g\u00e9n\u00e9ralement plus br\u00e8ve (rythme atrial plus rapide) lors d\u2019un flutter p\u00e9ri-cicatriciel que pour un flutter isthmo-d\u00e9pendant, le circuit \u00e9tant plus court. ","commentary_ecg":"La chirurgie r\u00e9paratrice d\u2019une t\u00e9tralogie de Fallot est moins \u201cd\u00e9labrante\u201d pour le massif auriculaire qu\u2019une intervention type Senning, Mustard ou Fontan. On retrouve toutefois une pr\u00e9valence \u00e9lev\u00e9e de troubles du rythme atriaux \u00e0 distance de la chirurgie. Typiquement, en dehors de la phase post-op\u00e9ratoire pr\u00e9coce, un espace libre de 10 \u00e0 15 ans sans survenue d\u2019arythmie atriale est observ\u00e9. La pr\u00e9valence augmente ensuite pour atteindre 20% \u00e0 l\u2019\u00e2ge adulte. M\u00eame si la chirurgie de cette pathologie n\u2019est pas centr\u00e9e sur l\u2019oreillette, diff\u00e9rents facteurs favorisent la survenue d\u2019arythmies atriales. En effet, l\u2019association entre atriotomie, cicatrice atriale droite, cannulation de l\u2019oreillette puis surcharge prolong\u00e9e en volume et\/ou en pression 1) entraine le d\u00e9veloppement d\u2019un remodelage \u00e9lectrophysiologique atrial droit diffus avec \u00e9tirement du massif atrial, distorsion de l\u2019orientation des fibres et 2) favorise la cr\u00e9ation d\u2019isthmes atriaux de conduction lente propices \u00e0 la macro-r\u00e9entr\u00e9e. Deux types d\u2019arythmie atriale droite organis\u00e9e sont d\u00e9crits : le flutter isthme cavo-tricuspide d\u00e9pendant et le flutter p\u00e9ri-cicatriciel. Les arythmies focales sont extr\u00eamement rares. Comme chez ce patient, les flutters dits communs isthmo- d\u00e9pendants sont les plus fr\u00e9quents. Un circuit de macro r\u00e9entr\u00e9e peut \u00e9galement \u00eatre favoris\u00e9 par la r\u00e9alisation d\u2019une atriotomie lat\u00e9rale droite avec survenue d\u2019un flutter p\u00e9ri-incisionnel. La dur\u00e9e du cycle de la r\u00e9entr\u00e9e atriale est g\u00e9n\u00e9ralement plus br\u00e8ve lors d\u2019un flutter p\u00e9ri-cicatriciel que pour un flutter isthmo-d\u00e9pendant, le circuit \u00e9tant plus court. L\u2019ablation d\u2019un flutter p\u00e9ri-incisionnel consiste \u00e0 r\u00e9aliser une ligne de bloc entre 2 obstacles anatomiques : g\u00e9n\u00e9ralement entre la partie basse de la cicatrice et la veine cave inf\u00e9rieure, plus rarement entre la cicatrice et la valve tricuspide ou entre la partie sup\u00e9rieure de la cicatrice et la veine cave sup\u00e9rieure. ","ecg_info_post_answer":"<img class=\"alignnone wp-image-10336 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-293-1024x492.png\" alt=\"\" width=\"800\" height=\"384\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 6.10: Flutter commun chez un patient avec cardiopathie cong\u00e9nitale - 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-6-10-flutter-commun-chez-un-patient-avec-cardiopathie-congenitale\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 6.10: Flutter commun chez un patient avec cardiopathie cong\u00e9nitale - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-10-flutter-commun-chez-un-patient-avec-cardiopathie-congenitale\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-02T20:53:57+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-10-flutter-commun-chez-un-patient-avec-cardiopathie-congenitale\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-10-flutter-commun-chez-un-patient-avec-cardiopathie-congenitale\/\",\"name\":\"Trac\u00e9 6.10: Flutter commun chez un patient avec cardiopathie cong\u00e9nitale - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-10-flutter-commun-chez-un-patient-avec-cardiopathie-congenitale\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-10-flutter-commun-chez-un-patient-avec-cardiopathie-congenitale\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-10-ecg-5-scaled.jpeg\",\"datePublished\":\"2026-04-02T20:53:56+00:00\",\"dateModified\":\"2026-04-02T20:53:57+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-10-flutter-commun-chez-un-patient-avec-cardiopathie-congenitale\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-6-10-flutter-commun-chez-un-patient-avec-cardiopathie-congenitale\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-10-flutter-commun-chez-un-patient-avec-cardiopathie-congenitale\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-10-ecg-5-scaled.jpeg\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-10-ecg-5-scaled.jpeg\",\"width\":2560,\"height\":1258},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-10-flutter-commun-chez-un-patient-avec-cardiopathie-congenitale\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 6.10: Flutter commun chez un patient avec cardiopathie cong\u00e9nitale\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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