{"id":10222,"date":"2026-04-03T14:17:41","date_gmt":"2026-04-03T14:17:41","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10222"},"modified":"2026-04-03T14:17:42","modified_gmt":"2026-04-03T14:17:42","slug":"trace-7-11-fibrillation-auriculaire-et-voie-accessoire","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-11-fibrillation-auriculaire-et-voie-accessoire\/","title":{"rendered":"Trac\u00e9 7.11: Fibrillation auriculaire et voie accessoire"},"content":{"rendered":"","protected":false},"featured_media":10221,"template":"","ecg_case_type":[256],"language_ecgcase":[259],"class_list":["post-10222","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 7.11: Fibrillation auriculaire et voie accessoire","patient_description":"Homme de 21 ans hospitalis\u00e9 pour syncope; premier trac\u00e9 enregistr\u00e9 alors que l\u2019\u00e9tat h\u00e9mo\u00ad dynamique du patient est pr\u00e9caire","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) possible(s) sur cet ECG?","quiz_answer_1":"torsade de pointes","quiz_answer_2":"fibrillation atriale sur voie accessoire","quiz_answer_3":"fibrillation ventriculaire","quiz_answer_4":"tachycardie orthodromique sur voie accessoire","quiz_answer_5":"tachycardie jonctionnelle ectopique","correct_answer":["B"],"ecg_image":10221,"ecg_description":"Aspect caract\u00e9ristique de fibrillation auriculaire sur voie accessoire; tachycardie irr\u00e9guli\u00e8re avec cycles RR tr\u00e8s courts (cycles mesur\u00e9s \u00e0 200 ms) avec variations cycle \u00e0 cycle de l\u2019aspect des QRS avec complexes QRS fins, QRS tr\u00e8s pr\u00e9-excit\u00e9s et QRS interm\u00e9diaires;","ecg_info_box":"L\u2019incidence de la fibrillation auriculaire est consid\u00e9rablement augment\u00e9e chez les patients pr\u00e9sentant un syndrome de Wolff parkinson White. L\u2019ablation de la voie accessoire permet de r\u00e9duire sensiblement la survenue de ce type d\u2019arythmie qui expose le patient au risque de mort subite. ","commentary_ecg":"Des \u00e9pisodes de fibrillation auriculaire sont document\u00e9s chez environ un tiers des patients pr\u00e9sentant un syndrome de Wolff Parkinson White. L\u2019incidence du flutter et des tachycardies atriales ne semble en revanche pas augment\u00e9e. Diff\u00e9rents m\u00e9canismes impliqu\u00e9s dans la gen\u00e8se de ces \u00e9pisodes ont \u00e9t\u00e9 sugg\u00e9r\u00e9s: 1) certaines tachycardies r\u00e9ciproques par r\u00e9entr\u00e9e d\u00e9g\u00e9n\u00e8rent spontan\u00e9ment en fibrillation auriculaire. Cliniquement, le patient ressent initialement une tachycardie r\u00e9guli\u00e8re et bien support\u00e9e qui devient dans un second temps irr\u00e9guli\u00e8re et souvent mal support\u00e9e. Lors d\u2019un \u00e9pisode de tachycardie antidromique ou orthodromique, les oreillettes sont activ\u00e9es de fa\u00e7on rapide et r\u00e9trograde ce qui peut favoriser la survenue d\u2019une fibrillation auriculaire. L\u2019incidence de la fibrillation auriculaire diminue consid\u00e9rablement apr\u00e8s une ablation effective de la voie accessoire. Ce m\u00e9canisme ne peut pas \u00eatre le seul impliqu\u00e9 dans la gen\u00e8se des arythmies dans la mesure o\u00f9 certains patients pr\u00e9sentent des \u00e9pisodes de fibrillation sans jamais avoir pr\u00e9sent\u00e9 au pr\u00e9alable de tachycardies r\u00e9ciproques; 2) il semble que la pr\u00e9sence d\u2019une voie accessoire induise des modifications de l\u2019architecture atriale et une augmentation de la vuln\u00e9rabilit\u00e9 atriale. Les \u00e9tudes \u00e9lectrophysiologiques retrouvent un substrat atrial favorable \u00e0 l\u2019arythmie avec mise en \u00e9vidence d\u2019\u00e9lectrogrammes endocavitaires atriaux fractionn\u00e9s et de dur\u00e9e prolong\u00e9e, de p\u00e9riodes r\u00e9fractaires atriales modifi\u00e9es et d\u2019un d\u00e9lai de conduction inter-atrial augment\u00e9. \r\n\r\nL\u2019existence d\u2019une fibrillation atriale conduite rapidement par la voie accessoire constitue l\u2019\u00e9l\u00e9ment pronostic d\u00e9terminant des patients pr\u00e9sentant une voie accessoire. Ce type d\u2019\u00e9pisode se traduit volontiers cliniquement par une lipothymie, une syncope ou une mort subite. Une voie accessoire est consid\u00e9r\u00e9e comme maligne quand sa p\u00e9riode r\u00e9fractaire ant\u00e9rograde est tr\u00e8s courte exposant le patient \u00e0 un rythme ventriculaire potentiellement tr\u00e8s rapide. Il est \u00e0 noter que la p\u00e9riode r\u00e9fractaire peut changer en fonction de l\u2019alt\u00e9ration h\u00e9modynamique ou d\u2019une modification de l\u2019\u00e9tat cat\u00e9cholergique. \r\n\r\nSur l\u2019\u00e9lectrocardiogramme, un \u00e9pisode de fibrillation atriale sur voie accessoire se traduit par un rythme ventriculaire irr\u00e9gulier avec alternance de QRS tr\u00e8s \u00e9largis (pr\u00e9-excitation majeure, aspect de super-Wolff), de QRS fins (conduction nodale exclusive) et de QRS interm\u00e9diaires (fusion). La succession de cycles plus ou moins pr\u00e9-excit\u00e9s avec des variations cycle \u00e0 cycle importantes de la partie initiale du QRS donne un aspect \u00e9lectrocardiographique \u201cen accord\u00e9on\u201d. L\u2019axe du QRS ne change pas ce qui permet de diff\u00e9rencier cet aspect de celui d\u2019une tachycardie ventriculaire polymorphe type torsade de pointes. \r\n\r\nCe patient a b\u00e9n\u00e9fici\u00e9 d\u2019une ablation par radiofr\u00e9quence de sa voie accessoire, l\u2019indication paraissant indiscutable dans ce cadre. ","ecg_info_post_answer":"\"\"\r\n\r\nDescription trac\u00e9<\/strong>\r\n\r\nCe patient a b\u00e9n\u00e9fici\u00e9 d\u2019un choc \u00e9lectrique sous br\u00e8ve s\u00e9dation; rythme sinusal avec aspect de pr\u00e9-excitation (PR court, onde delta) lat\u00e9rale gauche;"},"yoast_head":"\nTrac\u00e9 7.11: Fibrillation auriculaire et 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-7-11-fibrillation-auriculaire-et-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 7.11: Fibrillation auriculaire et voie accessoire - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-11-fibrillation-auriculaire-et-voie-accessoire\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-03T14:17:42+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-7-11-fibrillation-auriculaire-et-voie-accessoire\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-11-fibrillation-auriculaire-et-voie-accessoire\/\",\"name\":\"Trac\u00e9 7.11: Fibrillation auriculaire et voie accessoire - 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