{"id":10206,"date":"2026-04-03T13:48:51","date_gmt":"2026-04-03T13:48:51","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10206"},"modified":"2026-04-03T13:48:51","modified_gmt":"2026-04-03T13:48:51","slug":"trace-7-5-tachycardie-orthodromique-sur-voie-accessoire-cachee","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-5-tachycardie-orthodromique-sur-voie-accessoire-cachee\/","title":{"rendered":"Trac\u00e9 7.5: Tachycardie orthodromique sur voie accessoire cach\u00e9e"},"content":{"rendered":"","protected":false},"featured_media":10459,"template":"","ecg_case_type":[256],"language_ecgcase":[259],"class_list":["post-10206","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 7.5: Tachycardie orthodromique sur voie accessoire cach\u00e9e","patient_description":"Homme de 45 ans sans ant\u00e9c\u00e9dents hospitalis\u00e9 pour palpitations (plusieurs \u00e9pisodes depuis 1 mois durant une trentaine de minutes)","quiz_question":"Dans le cadre du bilan de palpitations, cet \u00e9lectrocardiogramme ne permet pas d\u2019\u00e9liminer le(s) diagnostic(s) suivant(s)?","quiz_answer_1":"fibrillation auriculaire","quiz_answer_2":"tachycardie ventriculaire","quiz_answer_3":"tachycardie orthodromique sur voie accessoire","quiz_answer_4":"flutter commun","quiz_answer_5":"r\u00e9entr\u00e9e intranodale","correct_answer":["A","B","C","D","E"],"ecg_image":10459,"ecg_description":"Cet \u00e9lectrocardiogramme r\u00e9alis\u00e9 en dehors d\u2019une crise de tachycardie est dans les limites de la normale;","ecg_info_box":"Une voie accessoire est dite cach\u00e9e quand il n\u2019y a pas de conduction ant\u00e9rograde; la survenue de tachycardies orthodromiques est possible si la conduction r\u00e9trograde par la voie accessoire est pr\u00e9serv\u00e9e; il n\u2019existe pas en revanche de risque de mort subite sur fibrillation auriculaire conduite rapidement.","commentary_ecg":"Nous avons d\u00e9taill\u00e9 sur le trac\u00e9 pr\u00e9c\u00e9dent les caract\u00e9ristiques \u00e9lectrocardiographiques en tachycardie d\u2019une r\u00e9entr\u00e9e orthodromique sur voie accessoire. Il est \u00e9vident que l\u2019existence en rythme sinusal d\u2019une pr\u00e9-excitation (PR court, onde delta) est en faveur d\u2019une tachycardie sur voie accessoire. A l\u2019oppos\u00e9, comme chez ce patient, un trac\u00e9 intercritique normal ne permet nullement d\u2019\u00e9liminer une r\u00e9entr\u00e9e sur voie accessoire par un faisceau de Kent cach\u00e9. Ce type de voie accessoire ne conduit que de fa\u00e7on r\u00e9trograde (des ventricules vers l\u2019oreillette) ce qui en rend l\u2019identification impossible sur une activit\u00e9 sinusale (pas de conduction ant\u00e9rograde). L\u2019exploration \u00e9lectrophysiologique a permis d\u2019induire la m\u00eame tachycardie et de mettre en \u00e9vidence une voie accessoire post\u00e9rieure gauche cach\u00e9e, c\u2019est \u00e0 dire conduisant uniquement en r\u00e9trograde. Ces patients sont expos\u00e9s au risque de tachycardies r\u00e9ciproques mais ne peuvent pas pr\u00e9senter de fibrillation auriculaire rapide conduite par la voie accessoire (pas de conduction ant\u00e9rograde) ce qui en limite la gravit\u00e9 et le risque de mort subite. Au vu des sympt\u00f4mes pr\u00e9sent\u00e9s par le patient, une ablation de la voie accessoire a quand m\u00eame \u00e9t\u00e9 propos\u00e9e. \r\n\r\nDans un faisceau de Kent cach\u00e9, il existe un certain degr\u00e9 de conduction ant\u00e9rograde sur la voie accessoire qui n\u2019est pas suffisante pour d\u00e9polariser les cellules ventriculaires et donner un aspect de pr\u00e9-excitation mais suffisant pour emp\u00eacher une conduction r\u00e9trograde syst\u00e9matique et la survenue de tachycardies permanentes. \r\n\r\nLors d\u2019une tachycardie avec \u00e9lectrocardiogramme sinusal normal, certains \u00e9l\u00e9ments peuvent sugg\u00e9rer l\u2019existence d\u2019une voie accessoire cach\u00e9e: le diagnostic est fait si on met en \u00e9vidence un bloc de branche homolat\u00e9ral ralentisseur; de m\u00eame, une onde P\u2019 n\u00e9gative en DI est tr\u00e8s en faveur d\u2019une r\u00e9entr\u00e9e sur voie accessoire lat\u00e9rale gauche. L\u2019exploration \u00e9lectrophysiologique permet de confirmer le diagnostic.","ecg_info_post_answer":"&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10460 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-5-ecg2-e1775224101112-808x1024.png\" alt=\"\" width=\"800\" height=\"1014\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nEnregistrement du d\u00e9marrage d\u2019une tachycardie; une extrasystole atriale est conduite par les voies normales avec un intervalle PR allong\u00e9; d\u00e9but d\u2019une tachycardie \u00e0 QRS fins et identiques aux complexes sinusaux; activit\u00e9 atriale difficile \u00e0 identifier mais semblant pr\u00e9sente en 1\/1 dans la partie ascendante de l\u2019onde T; le positionnement de l\u2019activit\u00e9 atriale est plut\u00f4t en faveur d\u2019une tachycardie orthodromique sur voie accessoire;"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 7.5: Tachycardie orthodromique sur voie accessoire cach\u00e9e - 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-7-5-tachycardie-orthodromique-sur-voie-accessoire-cachee\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 7.5: Tachycardie orthodromique sur voie accessoire cach\u00e9e - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-5-tachycardie-orthodromique-sur-voie-accessoire-cachee\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\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-7-5-tachycardie-orthodromique-sur-voie-accessoire-cachee\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-5-tachycardie-orthodromique-sur-voie-accessoire-cachee\/\",\"name\":\"Trac\u00e9 7.5: Tachycardie orthodromique sur voie accessoire cach\u00e9e - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-5-tachycardie-orthodromique-sur-voie-accessoire-cachee\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-5-tachycardie-orthodromique-sur-voie-accessoire-cachee\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-5-ecg-1-e1775223945867.png\",\"datePublished\":\"2026-04-03T13:48:51+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-5-tachycardie-orthodromique-sur-voie-accessoire-cachee\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-7-5-tachycardie-orthodromique-sur-voie-accessoire-cachee\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-5-tachycardie-orthodromique-sur-voie-accessoire-cachee\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-5-ecg-1-e1775223945867.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-5-ecg-1-e1775223945867.png\",\"width\":1470,\"height\":1843},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-5-tachycardie-orthodromique-sur-voie-accessoire-cachee\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 7.5: Tachycardie orthodromique sur voie accessoire cach\u00e9e\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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