{"id":10205,"date":"2026-04-03T13:42:51","date_gmt":"2026-04-03T13:42:51","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10205"},"modified":"2026-04-09T10:15:47","modified_gmt":"2026-04-09T10:15:47","slug":"trace-7-4-tachycardie-orthodromique-sur-voie-accessoire","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-4-tachycardie-orthodromique-sur-voie-accessoire\/","title":{"rendered":"Trac\u00e9 7.4: Tachycardie orthodromique sur voie accessoire"},"content":{"rendered":"","protected":false},"featured_media":10204,"template":"","ecg_case_type":[256],"language_ecgcase":[259],"class_list":["post-10205","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-junctional-tachycardia","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 7.4: Tachycardie orthodromique sur voie accessoire","patient_description":"Patient de 31 ans pr\u00e9sentant des palpitations \u00e0 d\u00e9but brutal et fin brutale; ECG enregistr\u00e9 au d\u00e9cours d\u2019un \u00e9pisode","quiz_question":"Concernant cet ECG, quel(s) est(sont) le(les) diagnostic(s) possible(s)?","quiz_answer_1":"fibrillation auriculaire","quiz_answer_2":"tachycardie ventriculaire","quiz_answer_3":"tachycardie orthodromique","quiz_answer_4":"flutter commun","quiz_answer_5":"r\u00e9entr\u00e9e nodale atypique","correct_answer":["C","E"],"ecg_image":10204,"ecg_description":"Tachycardie r\u00e9guli\u00e8re, \u00e0 180 bpm, QRS fins; activit\u00e9 atriale difficile \u00e0 visualiser mais semblant pr\u00e9sente dans l\u2019onde T avec un rapport 1\/1;","ecg_info_box":"Dans une tachycardie orthodromique, l\u2019influx descend de l\u2019oreillette au ventricule par le faisceau de His et remonte par le faisceau de Kent; la tachycardie est r\u00e9guli\u00e8re, \u00e0 d\u00e9but et fin brutal, avec un rapport A\/V en 1\/1, l\u2019espace P\u2019R \u00e9tant plus long que l\u2019espace RP\u2019;","commentary_ecg":"Ce patient pr\u00e9sentait donc des \u00e9pisodes it\u00e9ratifs de tachycardie r\u00e9ciproque sur un faisceau de Kent (voie accessoire, syndrome de Wolff Parkinson White). Le trac\u00e9 enregistr\u00e9 correspond \u00e0 une tachycardie orthodromique: le circuit tachycardique est large, l\u2019influx descendant de l\u2019oreillette au ventricule par le faisceau de His et remontant par le faisceau de Kent.\r\n\r\nCe type de tachycardie, bien plus fr\u00e9quent que les tachycardies antidromiques o\u00f9 le circuit est invers\u00e9, pr\u00e9sente certaines caract\u00e9ristiques \u00e9lectrocardiographiques: 1) les \u00e9pisodes de tachycardie sont \u00e0 d\u00e9but et fin brusques avec un rapport 1\/1 entre oreillettes et ventricules; il y a obligatoirement autant d\u2019oreillettes que de ventricules; en effet \u00e0 la diff\u00e9rence des tachycardies par r\u00e9entr\u00e9e intranodale, oreillettes et ventricules sont des parties int\u00e9grantes du circuit, il ne peut donc pas y avoir d\u2019activation atriale ou ventriculaire d\u00e9ficitaire;\r\n\r\n2) la fr\u00e9quence de la tachycardie varie g\u00e9n\u00e9ralement entre 150 et 250 bpm suivant les patients mais reste relativement fixe d\u2019un acc\u00e8s \u00e0 l\u2019autre chez le m\u00eame patient; 3) dans la grande majorit\u00e9 des cas, il s\u2019agit de tachycardies \u00e0 QRS fins (activation ventriculaire li\u00e9e exclusivement \u00e0 la descente par le faisceau de His) m\u00eame si un \u00e9largissement des complexes QRS est possible dans le cadre d\u2019un bloc de branche pr\u00e9existant ou de l\u2019apparition d\u2019une aberration ventriculaire tachy-d\u00e9pendante; la pr\u00e9sence d\u2019une alternance de l\u2019amplitude des QRS (alternance entre 2 QRS fins d\u2019amplitude diff\u00e9rente) est fr\u00e9quente mais est un signe non sp\u00e9cifique;\r\n\r\n4) l\u2019onde P\u2019 en tachycardie se situe dans le segment ST un peu \u00e0 distance du QRS et est donc souvent difficile \u00e0 identifier (comme sur ce trac\u00e9) en raison de la superposition avec la repolarisation ventriculaire ; la morphologie de l\u2019onde P\u2019 en tachycardie varie d\u2019un patient \u00e0 l\u2019autre car elle d\u00e9pend de la zone d\u2019insertion auriculaire de la voie accessoire qui modifie le site de la primo-d\u00e9polarisation auriculaire ainsi que le vecteur d\u2019activation atriale; la morphologie de l\u2019onde P\u2019 peut parfois aider \u00e0 la d\u00e9termination de la localisation du faisceau de Kent; en effet, une onde P\u2019 n\u00e9gative dans les d\u00e9rivations DI et aVL est en faveur d\u2019une voie accessoire lat\u00e9rale gauche (d\u00e9polarisation atriale d\u00e9butant \u00e0 la paroi lat\u00e9rale gauche avec activation auriculaire de la gauche vers la droite); la conduction r\u00e9trograde par une voie accessoire de topographie septale entraine une s\u00e9quence de d\u00e9polarisation atriale tr\u00e8s proche de celle observ\u00e9e lors d\u2019une conduction r\u00e9trograde provenant du n\u0153ud auriculo- ventriculaire (r\u00e9entr\u00e9e intranodale, tachycardie antidromique);\r\n\r\n5) l\u2019emplacement des ondes P\u2019 par rapport aux complexes QRS est variable et d\u00e9pend des vitesses de conduction respectives dans la voie nodo-hisienne (conduction ant\u00e9rograde), le myocarde ventriculaire, la voie accessoire (conduction r\u00e9trograde) et le myocarde atrial; l\u2019espace P\u2019R (travers\u00e9e du filtre nodal) reste plus long que l\u2019espace RP\u2019;\r\n\r\n6) le d\u00e9marrage d\u2019un \u00e9pisode de tachycardie r\u00e9ciproque sur voie accessoire n\u2019est possible que si l\u2019une des voies se bloque, l\u2019autre restant perm\u00e9able; cette condition peut parfois \u00eatre remplie par de simples variations du rythme sinusal; dans la grande majorit\u00e9 de cas, l\u2019\u00e9pisode d\u00e9bute \u00e0 la suite d\u2019une extrasystole atriale avec un timing tr\u00e8s pr\u00e9cis en termes de p\u00e9riodes r\u00e9fractaires des voies de conduction normales et accessoires; une extrasystole atriale pr\u00e9coce descend exclusivement par le faisceau de His (bloqu\u00e9e par le faisceau de Kent car en p\u00e9riode r\u00e9fractaire) avec un aspect non pr\u00e9-excit\u00e9 (pas d\u2019onde delta); \u00e0 la suite de l\u2019activation ventriculaire, survient un \u00e9cho auriculaire par le faisceau accessoire (la voie accessoire n\u2019est plus en p\u00e9riode r\u00e9fractaire et peut conduire en r\u00e9trograde) qui est l\u2019amorce d\u2019un mouvement circulaire, l\u2019activit\u00e9 atriale \u00e9tant ensuite de nouveau conduite aux ventricules par les voies normales, le cycle se reproduisant \u00e0 l\u2019identique; une extrasystole ventriculaire peut \u00e9galement plus rarement \u00eatre d\u00e9clenchante (bloqu\u00e9e dans la voie nodo-hisienne, envahit l\u2019oreillette par le faisceau accessoire et redescend aux ventricules par la voie normale);\r\n\r\n7) la terminaison de l\u2019\u00e9pisode peut \u00eatre spontan\u00e9e (le plus souvent sur une derni\u00e8re onde P\u2019 mais parfois sur une onde R, une extrasystole ventriculaire ou un passage en fibrillation atriale) ou provoqu\u00e9e par une stimulation vagale, l\u2019interruption \u00e9tant alors g\u00e9n\u00e9ralement pr\u00e9c\u00e9d\u00e9e d\u2019un allongement progressif des derniers cycles RR tachycardiques correspondant \u00e0 un allongement de l\u2019intervalle AH;\r\n\r\n","ecg_info_post_answer":"<img class=\"alignnone wp-image-10456 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-4-ecg2-1024x647.png\" alt=\"\" width=\"800\" height=\"505\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nMassage sino-carotidien; arr\u00eat de la tachycardie; reprise d\u2019un rythme sinusal avec pr\u00e9-excitation \u00e9vidente (PR court + onde delta); troubles de la repolarisation en rapport avec la pr\u00e9-excitation;\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10457 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-4-ecg3-1024x508.png\" alt=\"\" width=\"800\" height=\"397\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\n\u00c9lectrocardiogramme r\u00e9alis\u00e9 apr\u00e8s ablation d\u2019une voie accessoire; disparition de la pr\u00e9-excitation, PR normal et mise en \u00e9vidence d\u2019une onde q septale en V5-V6 physiologique; repolarisation pr\u00e9coce;\r\n\r\n<img class=\"alignnone wp-image-10351 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-354-1024x400.png\" alt=\"\" width=\"800\" height=\"313\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 7.4: Tachycardie orthodromique sur voie accessoire - 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-7-4-tachycardie-orthodromique-sur-voie-accessoire\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 7.4: Tachycardie orthodromique sur voie accessoire - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-4-tachycardie-orthodromique-sur-voie-accessoire\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-09T10:15:47+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-4-ecg-2.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1210\" \/>\n\t<meta property=\"og:image:height\" content=\"765\" \/>\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-7-4-tachycardie-orthodromique-sur-voie-accessoire\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-4-tachycardie-orthodromique-sur-voie-accessoire\/\",\"name\":\"Trac\u00e9 7.4: Tachycardie orthodromique sur voie accessoire - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-4-tachycardie-orthodromique-sur-voie-accessoire\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-4-tachycardie-orthodromique-sur-voie-accessoire\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-4-ecg-2.png\",\"datePublished\":\"2026-04-03T13:42:51+00:00\",\"dateModified\":\"2026-04-09T10:15:47+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-4-tachycardie-orthodromique-sur-voie-accessoire\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-7-4-tachycardie-orthodromique-sur-voie-accessoire\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-4-tachycardie-orthodromique-sur-voie-accessoire\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-4-ecg-2.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-4-ecg-2.png\",\"width\":1210,\"height\":765},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-4-tachycardie-orthodromique-sur-voie-accessoire\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 7.4: Tachycardie orthodromique sur voie accessoire\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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