{"id":10214,"date":"2026-04-03T14:07:36","date_gmt":"2026-04-03T14:07:36","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10214"},"modified":"2026-04-03T14:07:36","modified_gmt":"2026-04-03T14:07:36","slug":"trace-7-8-faisceau-de-mahaim","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-8-faisceau-de-mahaim\/","title":{"rendered":"Trac\u00e9 7.8: Faisceau de \u201cmaha\u00efm\u201d"},"content":{"rendered":"","protected":false},"featured_media":10469,"template":"","ecg_case_type":[256],"language_ecgcase":[259],"class_list":["post-10214","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 7.8: Faisceau de \u201cmaha\u00efm\u201d","patient_description":"Patient de 26 ans hospitalis\u00e9 pour palpitations \u00e0 d\u00e9but brutal et fin brutale; ECG enregistr\u00e9 au d\u00e9cours d\u2019un \u00e9pisode","quiz_question":"Quell(s) est(sont) le(s) diagnostic(s) possible(s) sur cet ECG?","quiz_answer_1":"fibrillation auriculaire","quiz_answer_2":"tachycardie ventriculaire","quiz_answer_3":"tachycardie orthodromique","quiz_answer_4":"flutter avec bloc de branche gauche","quiz_answer_5":"flutter avec bloc de branche droit","correct_answer":["B","C","D"],"ecg_image":10469,"ecg_description":"Le trac\u00e9 montre une tachycardie \u00e0 180 bpm, retard gauche, axe gauche; activit\u00e9 atriale difficile \u00e0 individualiser (possible rapport 1\/1 avec activit\u00e9 atriale dans l\u2019onde T);","ecg_info_box":"Initialement un faisceau de Maha\u00efm correspond \u00e0 des fibres fasciculo-ventriculaires ou nodo-ventriculaires; on parle aujourd\u2019hui de \u201cpseudo-Maha\u00efm\u201d dans le cadre de fibres atrio-fasciculaires ou atrio-ventriculaires avec conduction d\u00e9cr\u00e9mentielle et possibilit\u00e9 de tachycardies antidromiques \u00e0 QRS large avec aspect de retard gauche et d\u00e9viation axiale gauche","commentary_ecg":"L\u2019aspect de la tachycardie et de l\u2019\u00e9lectrocardiogramme en rythme sinusal est \u00e9vocateur d\u2019une tachycardie sur voie accessoire dite de Maha\u00efm. Une proc\u00e9dure d\u2019exploration \u00e9lectrophysiologique a permis de mettre en \u00e9vidence une voie accessoire atrio-fasciculaire droite avec conduction d\u00e9cr\u00e9mentielle qui a \u00e9t\u00e9 ablat\u00e9e supprimant les tachycardies et corrigeant l\u2019aspect de pr\u00e9-excitation sur l\u2019\u00e9lectrocardiogramme sinusal.\r\n\r\nEn 1937, Maha\u00efm avait initialement d\u00e9crit des fibres assurant une connexion entre le faisceau de His et le myocarde ventriculaire droit (fasciculo-ventriculaires); le terme de fibres de Maha\u00efm a ensuite \u00e9t\u00e9 \u00e9tendu aux connexions entre le n\u0153ud atrio-ventriculaire et le myocarde (nodo-ventriculaires). Les fibres fasciculo- ventriculaires sont rares mais leur fr\u00e9quence r\u00e9elle est minimis\u00e9e par l\u2019absence de traduction clinique. L\u2019espace PR est normal et le complexe QRS peut \u00eatre \u00e9largi avec un emp\u00e2tement initial. Les fibres nodo-ventriculaires sont encore beaucoup plus rares et exposent \u00e0 des crises de tachycardie r\u00e9ciproque (QRS large, aspect de retard gauche). Les oreillettes ne sont pas inclues dans le circuit de r\u00e9entr\u00e9e. En rythme sinusal, l\u2019intervalle PR est normal ou un peu court, le complexe QRS est normal ou peu modifi\u00e9. Pendant de nombreuses ann\u00e9es, l\u2019association suivante sugg\u00e9rait l\u2019existence de fibres de Maha\u00efm: 1) tachycardie 1\/1 \u00e0 QRS large, retard gauche, 2) aspect peu ou pas pr\u00e9-excit\u00e9 en rythme sinusal, 3) exploration \u00e9lectrophysiologique caract\u00e9ristique: espace AH normal, espace HV court; sous stimulation atriale \u00e0 fr\u00e9quence croissante: les intervalles PR et AH s\u2019allongent, l\u2019espace HV se raccourcit et le QRS prend un aspect de retard gauche, la d\u00e9polarisation d\u00e9pendant du faisceau accessoire.\r\n\r\nIl apparait en fait qu\u2019un nombre important de voies accessoires r\u00e9pondant \u00e0 ce tableau ne correspondent pas \u00e0 la topologie d\u00e9crite par Maha\u00efm mais sont comme chez ce patient de type atrio-fasciculaire ou atrio-ventriculaire. On parle alors de \u201cpseudo- Maha\u00efm\u201d. Les tachycardies \u00e0 retard gauche sont li\u00e9es \u00e0 l\u2019utilisation ant\u00e9rograde de connexions atrio-ventriculaires particuli\u00e8res situ\u00e9es sur la paroi lat\u00e9rale de l\u2019anneau tricuspidien, \u00e0 distance du n\u0153ud auriculo-ventriculaire, avec une insertion ventriculaire septale vers l\u2019\u00e9mergence de la branche droite et des propri\u00e9t\u00e9s de conduction d\u00e9cr\u00e9mentielle. La conduction ant\u00e9rograde se fait par la voie accessoire et la r\u00e9trograde par le n\u0153ud auriculo-ventriculaire ou un second faisceau accessoire. Il s\u2019agit de voies accessoires droites assimilables par certaines de leurs propri\u00e9t\u00e9s (conduction lente et d\u00e9cr\u00e9mentielle) \u00e0 un n\u0153ud auriculo-ventriculaire accessoire situ\u00e9 sur la paroi lat\u00e9rale de l\u2019anneau tricuspidien. Ces voies accessoires ont un comportement \u00e9lectrophysiologique proche de celui des fibres d\u00e9crites initialement par Maha\u00efm avec allongement de l\u2019intervalle AH et raccourcissement de l\u2019intervalle HV contemporain de l\u2019apparition du retard gauche lors d\u2019une stimulation atriale \u00e0 fr\u00e9quence croissante. Les tachycardies sont de type exclusivement antidromique, ce type de fibres ne conduisant qu\u2019en ant\u00e9rograde (pas de conduction r\u00e9trograde). Seule la dissociation atrio-ventriculaire est impossible alors qu\u2019elle est possible avec les fibres de Maha\u00efm classiques car l\u2019oreillette fait partie int\u00e9grante du circuit de r\u00e9entr\u00e9e. L\u2019aspect typique d\u2019une tachycardie sur ce type de voie accessoire inclut un QRS large, un aspect de retard gauche (ces voies sont ventriculaires droites), une d\u00e9viation axiale gauche, une transition pr\u00e9cordiale du complexe QRS le plus souvent tardive (rapport R\/S > 1). L\u2019\u00e9lectrocardiogramme en rythme sinusal montre un espace PR souvent normal ou mod\u00e9r\u00e9ment raccourci (possible association avec une conduction am\u00e9lior\u00e9e de la voie nodo-hisienne), une pr\u00e9-excitation modeste (aspect de bloc de branche gauche incomplet) ou absente du complexe QRS (pas d\u2019onde delta), un des seuls signes visibles pouvant \u00eatre la disparition de l\u2019onde q septale en V5-V6. La proc\u00e9dure d\u2019exploration \u00e9lectrophysiologique retrouve les caract\u00e9ristiques de ce type de voie: conduction ant\u00e9rograde exclusive avec conduction d\u00e9cr\u00e9mentielle; mise en \u00e9vidence d\u2019un potentiel particulier (potentiel M) g\u00e9n\u00e9r\u00e9 par la voie accessoire au niveau de l\u2019anneau tricuspidien dans sa portion lat\u00e9rale. Ce potentiel repr\u00e9sente la cible de la proc\u00e9dure d\u2019ablation.","ecg_info_post_answer":"<img class=\"alignnone wp-image-10470 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-8-ecg2-1024x724.jpeg\" alt=\"\" width=\"800\" height=\"566\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nLa tachycardie s\u2019interrompt suite \u00e0 des man\u0153uvres vagales; aspect de PR relativement court avec QRS l\u00e9g\u00e8rement pr\u00e9-excit\u00e9;"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 7.8: Faisceau de \u201cmaha\u00efm\u201d - 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-7-8-faisceau-de-mahaim\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 7.8: Faisceau de \u201cmaha\u00efm\u201d - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-8-faisceau-de-mahaim\/\" \/>\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-7-8-faisceau-de-mahaim\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-8-faisceau-de-mahaim\/\",\"name\":\"Trac\u00e9 7.8: Faisceau de \u201cmaha\u00efm\u201d - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-8-faisceau-de-mahaim\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-8-faisceau-de-mahaim\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-8-ecg.jpg\",\"datePublished\":\"2026-04-03T14:07:36+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-8-faisceau-de-mahaim\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-7-8-faisceau-de-mahaim\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-8-faisceau-de-mahaim\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-8-ecg.jpg\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-8-ecg.jpg\",\"width\":2507,\"height\":1773},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-8-faisceau-de-mahaim\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 7.8: Faisceau de \u201cmaha\u00efm\u201d\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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