{"id":10210,"date":"2026-04-03T14:03:58","date_gmt":"2026-04-03T14:03:58","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10210"},"modified":"2026-04-09T10:23:14","modified_gmt":"2026-04-09T10:23:14","slug":"trace-7-7-tachycardie-antidromique-sur-voie-accessoire","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-7-tachycardie-antidromique-sur-voie-accessoire\/","title":{"rendered":"Trac\u00e9 7.7: Tachycardie antidromique sur voie accessoire"},"content":{"rendered":"","protected":false},"featured_media":10209,"template":"","ecg_case_type":[256],"language_ecgcase":[259],"class_list":["post-10210","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 7.7: Tachycardie antidromique sur voie accessoire","patient_description":"Homme de 63 ans avec nombreux facteurs de risque hospitalis\u00e9 pour palpitations; ECG en\u00ad registr\u00e9 lors d\u2019un \u00e9pisode de tachycardie bien support\u00e9e sur le plan h\u00e9modynamique","quiz_question":"Concernant cet ECG, quelle(s) est(sont) le(s) diagnostic(s) possible(s)?","quiz_answer_1":"tachycardie sinusale","quiz_answer_2":"tachycardie ventriculaire","quiz_answer_3":"tachycardie antidromique sur voie accessoire","quiz_answer_4":"tachycardie orthodromique sur voie accessoire","quiz_answer_5":"r\u00e9entr\u00e9e intranodale","correct_answer":["B","C"],"ecg_image":10209,"ecg_description":"Tachycardie \u00e0 180 bpm, \u00e0 QRS large, retard droit, axe sup\u00e9rieur; pente ascendante du QRS tr\u00e8s \u201cmolle\u201d dans toutes les d\u00e9rivations pr\u00e9cordiales; activit\u00e9 atriale difficile \u00e0 individualiser (possibilit\u00e9 d\u2019un rapport VA 1\/1 avec oreillette dans la branche ascendante de l\u2019onde T); ce patient est adress\u00e9 en urgence \u00e0 la suite du diagnostic de probable tachycardie ventriculaire; \r\n\r\n","ecg_info_box":"Ce patient pr\u00e9sentait donc une voie accessoire lat\u00e9rale gauche masqu\u00e9e (conduction","commentary_ecg":"-","ecg_info_post_answer":"&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10466 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-7-ecg2-e1775224727303-1024x508.jpeg\" alt=\"\" width=\"800\" height=\"397\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nLa fin de la tachycardie n\u2019a pas \u00e9t\u00e9 enregistr\u00e9e; apr\u00e8s le retour en rythme sinusal, aspect de PR court sans pr\u00e9-excitation \u00e9vidente, possible s\u00e9quelle de n\u00e9crose inf\u00e9rieure et ant\u00e9ro-lat\u00e9rale;\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10353 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-370-1024x492.png\" alt=\"\" width=\"800\" height=\"384\" \/>\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10467 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-7-ecg3-1024x746.jpeg\" alt=\"\" width=\"800\" height=\"583\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nAu cours de l\u2019hospitalisation, nouvel \u00e9pisode de tachycardie; tachycardie \u00e0 QRS fin\r\n\r\n&nbsp;\r\n\r\n<strong>Commentaires<\/strong>\r\n\r\nCe patient pr\u00e9sentait donc une voie accessoire lat\u00e9rale gauche masqu\u00e9e (conduction ant\u00e9rograde uniquement visible apr\u00e8s injection d\u2019Ad\u00e9nosine) et des \u00e9pisodes de tachycardie orthodromique (QRS fins) et antidromique (QRS large, aspect majeur de pr\u00e9-excitation). Ce cas clinique illustre la difficult\u00e9 de diagnostic devant une tachycardie antidromique prise \u00e0 tort pour une tachycardie ventriculaire.\r\n\r\nLes tachycardies orthodromiques sont les arythmies les plus fr\u00e9quentes rencontr\u00e9es cliniquement chez les patients pr\u00e9sentant un syndrome de Wolff\u2013Parkinson\u2013White. Les tachycardies antidromiques, o\u00f9 le circuit est invers\u00e9 sont beaucoup plus rares, puisque document\u00e9es chez 5% environ des patients avec voie accessoire ou inductibles en salle d\u2019\u00e9lectrophysiologie chez moins de 10% de ces patients. L\u2019influx descend de l\u2019oreillette aux ventricules par un faisceau accessoire (conduction ant\u00e9rograde) et remonte vers l\u2019oreillette de fa\u00e7on r\u00e9trograde par la voie nodo-hisienne avant de descendre \u00e0 nouveau par le faisceau accessoire. Dans de rares cas, l\u2019influx peut remonter vers les oreillettes \u00e0 travers une seconde voie accessoire. Le d\u00e9marrage de ce type de tachycardie n\u00e9cessite un bloc unidirectionnel dans l\u2019une des deux voies de conduction atrio-ventriculaires. A l\u2019inverse des tachycardies orthodromiques, une extrasystole atriale est conduite en ant\u00e9rograde par le faisceau de Kent mais bloqu\u00e9e par les voies normales ou une extrasystole ventriculaire remonte par les voies de conduction normales mais est bloqu\u00e9e dans le faisceau de Kent. Diff\u00e9rents articles sugg\u00e8rent que les tachycardies antidromiques sont pr\u00e9f\u00e9rentiellement observ\u00e9es chez les patients avec des voies accessoires multiples ou avec une voie accessoire lat\u00e9rale situ\u00e9e \u00e0 distance du n\u0153ud atrio-ventriculaire. Il semble que pour induire cette arythmie, une distance critique minimale est n\u00e9cessaire, l\u2019influx devant \u00eatre bloqu\u00e9 dans le n\u0153ud, conduire par la voie accessoire, atteindre l\u2019apex ventriculaire puis remonter vers le n\u0153ud pour permettre la conduction r\u00e9trograde vers les oreillettes sans rencontrer les voies de conduction en p\u00e9riode r\u00e9fractaire.\r\n\r\nLa prise en charge des tachycardies antidromiques est parfois difficile du fait de leur raret\u00e9 et de leur aspect \u00e9lectrocardiographique de tachycardie \u00e0 QRS large (l\u2019activation ventriculaire se fait exclusivement \u00e0 travers la voie accessoire) pouvant faire suspecter le diagnostic de tachycardie ventriculaire.\r\n\r\nUne tachycardie antidromique pr\u00e9sente un aspect \u00e9lectrocardiographique peu sp\u00e9cifique qu\u2019il faut diff\u00e9rencier d\u2019une arythmie supra-ventriculaire 1\/1 avec aberration de conduction et d\u2019une tachycardie ventriculaire avec conduction r\u00e9trograde. Le diagnostic est parfois difficile comme chez ce patient quand l\u2019existence de la voie accessoire n\u2019est pas connue et que la pr\u00e9-excitation n\u2019est pas visible sur les complexes sinusaux (voie lat\u00e9rale gauche masqu\u00e9e).\r\n\r\nL\u2019\u00e9lectrocardiogramme montre:\r\n\r\n\u2022 Une tachycardie rapide, r\u00e9guli\u00e8re, \u00e0 QRS large\r\n\r\n\u2022 Un aspect de \u201csuper-Wolff\u201d (pr\u00e9-excitation majeure et maximale) puisque l\u2019int\u00e9gralit\u00e9 de l\u2019activation ventriculaire provient de la voie accessoire\r\n\r\n\u2022 L\u2019absence de complexes de capture ou de fusion (diagnostic diff\u00e9rentiel avec une tachycardie ventriculaire\r\n\r\n\u2022 Une association entre oreillettes et ventricules en 1\/1\r\n\r\n\u2022 L\u2019intervalle RP\u2019 est plus long que pour une r\u00e9entr\u00e9e intra-nodale\r\n\r\n\u2022 L\u2019aspect de l\u2019onde P\u2019 r\u00e9trograde est le m\u00eame que pour une r\u00e9entr\u00e9e intra-nodale puisque d\u00e9pendant du n\u0153ud atrio-ventriculaire (n\u00e9gative dans les d\u00e9rivations inf\u00e9rieures); l\u2019activit\u00e9 atriale est souvent difficilement analysable car elle survient dans l\u2019onde T du QRS pr\u00e9c\u00e9dent\r\n\r\nLa mise en \u00e9vidence de tachycardies antidromiques pourraient constituer un facteur de mauvais pronostic puisqu\u2019associ\u00e9es avec un risque accru de formes malignes. En effet, ce type de tachycardie est plus fr\u00e9quemment observ\u00e9 chez des patients avec de multiples voies accessoires. De plus, il semble que la survenue d\u2019une tachycardie antidromique soit un marqueur de bonne conductibilit\u00e9 \u00e0 travers la voie.\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10468 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-7-ecg4-1024x730.jpeg\" alt=\"\" width=\"800\" height=\"570\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nInterruption de la tachycardie au cours de l\u2019injection d\u2019une ampoule d\u2019Ad\u00e9nosine; apr\u00e8s retour en rythme sinusal, mise en \u00e9vidence d\u2019une pr\u00e9excitation majeure qui \u00e9tait masqu\u00e9e sur le trac\u00e9 en rythme sinusal pr\u00e9c\u00e9dent; la conduction par le noeud atrio-ventriculaire a \u00e9t\u00e9 compl\u00e8tement bloqu\u00e9e par l\u2019injection d\u2019Ad\u00e9nosine, la conduction se fait maintenant exclusivement par la voie accessoire; l\u2019aspect des QRS est identique \u00e0 celui observ\u00e9 sur la premi\u00e8re tachycardie sugg\u00e9rant qu\u2019il s\u2019agissait d\u2019une tachycardie antidromique;\r\n\r\n<img class=\"alignnone wp-image-10354 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-374-1024x491.png\" alt=\"\" width=\"800\" height=\"384\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - 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