{"id":10224,"date":"2026-04-03T14:19:44","date_gmt":"2026-04-03T14:19:44","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10224"},"modified":"2026-04-03T14:20:26","modified_gmt":"2026-04-03T14:20:26","slug":"trace-7-12-fibrillation-auriculaire-voie-accessoire-et-risque-de-mort-subite","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-12-fibrillation-auriculaire-voie-accessoire-et-risque-de-mort-subite\/","title":{"rendered":"Trac\u00e9 7.12: Fibrillation auriculaire, voie accessoire et risque de mort subite"},"content":{"rendered":"","protected":false},"featured_media":10223,"template":"","ecg_case_type":[256],"language_ecgcase":[259],"class_list":["post-10224","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 7.12: Fibrillation auriculaire, voie accessoire et risque de mort subite","patient_description":"Jeune homme de 17 ans sans ant\u00e9c\u00e9dent particulier ayant pr\u00e9sent\u00e9 une mort subite r\u00e9cu\u00ad p\u00e9r\u00e9e lors d\u2019un match de football (choc \u00e9lectrique d\u00e9livr\u00e9 \u00e0 l\u2019aide d\u2019un d\u00e9fibrillateur externe semi-automatique); patient adress\u00e9 dans le service; un aspect de voie accessoire est mis en \u00e9vidence; une exploration \u00e9lectrophysiologique est r\u00e9alis\u00e9e pour mesurer les p\u00e9riodes r\u00e9\u00ad fractaires ant\u00e9rogrades de la voie accessoire","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) possible(s) sur cet ECG?","quiz_answer_1":"bloc de branche gauche","quiz_answer_2":"activit\u00e9 atriale sinusale","quiz_answer_3":"voie accessoire","quiz_answer_4":"syndrome coronaire aigu inf\u00e9rieur","quiz_answer_5":"fibrillation auriculaire","correct_answer":["C","E"],"ecg_image":10223,"ecg_description":"Une exploration \u00e9lectrophysiologique est r\u00e9alis\u00e9e pour mesurer les p\u00e9riodes r\u00e9fractaires ant\u00e9rogrades de la voie accessoire; stimulation atriale rapide et injection d\u2019isoprot\u00e9r\u00e9nol pour favoriser la conduction dans la voie accessoire; trac\u00e9 typique de fibrillation sur voie accessoire avec aspect en accord\u00e9on caract\u00e9ristique; existence de cycles RR tr\u00e8s courts;","ecg_info_box":"L\u2019existence d\u2019une fibrillation atriale conduite rapidement par la voie accessoire constitue l\u2019\u00e9l\u00e9ment pronostic d\u00e9terminant de ces patients. Une p\u00e9riode r\u00e9fractaire ant\u00e9rograde courte expose le patient au risque de mort subite et constitue une indication formelle d\u2019ablation.","commentary_ecg":" Le syndrome de Wolff Parkinson White est parfois consid\u00e9r\u00e9 comme b\u00e9nin et un traitement est habituellement propos\u00e9 chez les patients symptomatiques pr\u00e9sentant des \u00e9pisodes de tachycardies r\u00e9ciproques. Toutefois, comme vu pr\u00e9c\u00e9demment, l\u2019incidence de la fibrillation auriculaire est \u00e9lev\u00e9e en d\u00e9pit de l\u2019absence de signes \u00e9vidents de cardiopathie organique. La survenue de ce type d\u2019arythmie peut grever le risque vital du patient, une r\u00e9ponse ventriculaire tr\u00e8s rapide sur une voie accessoire tr\u00e8s perm\u00e9able (p\u00e9riode r\u00e9fractaire ant\u00e9rograde tr\u00e8s courte) pouvant d\u00e9g\u00e9n\u00e9rer en fibrillation ventriculaire l\u00e9tale.\r\n\r\nLa difficult\u00e9 de la prise en charge des patients avec voie accessoire r\u00e9side dans le fait qu\u2019un \u00e9pisode de fibrillation atriale rapide conduisant \u00e0 une mort subite peut \u00eatre inaugural dans l\u2019histoire de la maladie et survenir chez un patient au pr\u00e9alable asymptomatique. Identifier les patients \u00e0 risque reste difficile m\u00eame si il est admis que le risque de mort subite est maximal chez les patients pr\u00e9sentant une p\u00e9riode r\u00e9fractaire ant\u00e9rograde tr\u00e8s courte (inf\u00e9rieure \u00e0 220 ms).\r\n\r\nDevant un patient pr\u00e9sentant un \u00e9pisode de fibrillation auriculaire sur voie accessoire, le traitement curatif repose sur la cardioversion en urgence si l\u2019h\u00e9modynamique est instable, sur les antiarythmiques de classe IC ou l\u2019amiodarone si l\u2019h\u00e9modynamique est conserv\u00e9e. En revanche, les m\u00e9dicaments bloquant la conduction nodale et ne ralentissant pas la conduction par la voie accessoire (ad\u00e9nosine, inhibiteurs calciques, b\u00eatabloquants, digitalique) sont formellement contre-indiqu\u00e9s.\r\n\r\nL\u2019existence de QRS pr\u00e9-excit\u00e9s avec cycles RR tr\u00e8s courts lors d\u2019une exploration ou l\u2019existence d\u2019un \u00e9pisode de fibrillation atriale mal support\u00e9e cliniquement constituent une indication indiscutable \u00e0 l\u2019ablation par radiofr\u00e9quence.\r\n","ecg_info_post_answer":"<img class=\"alignnone wp-image-10474 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-12-ecg2-1024x761.png\" alt=\"\" width=\"800\" height=\"595\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nCycles RR extr\u00eamement courts; dans la deuxi\u00e8me partie du trac\u00e9, le rythme d\u00e9g\u00e9n\u00e8re en fibrillation ventriculaire (activit\u00e9 anarchique); perte de connaissance du patient; un choc \u00e9lectrique est alors n\u00e9cessaire pour r\u00e9tablir un rythme sinusal efficace;\r\n\r\n<img class=\"alignnone wp-image-10358 size-full\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-396.png\" alt=\"\" width=\"358\" height=\"605\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 7.12: Fibrillation auriculaire, voie accessoire et risque de mort subite - 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-7-12-fibrillation-auriculaire-voie-accessoire-et-risque-de-mort-subite\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 7.12: Fibrillation auriculaire, voie accessoire et risque de mort subite - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-12-fibrillation-auriculaire-voie-accessoire-et-risque-de-mort-subite\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-03T14:20:26+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-7-12-fibrillation-auriculaire-voie-accessoire-et-risque-de-mort-subite\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-12-fibrillation-auriculaire-voie-accessoire-et-risque-de-mort-subite\/\",\"name\":\"Trac\u00e9 7.12: Fibrillation auriculaire, voie accessoire et risque de mort subite - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-12-fibrillation-auriculaire-voie-accessoire-et-risque-de-mort-subite\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-12-fibrillation-auriculaire-voie-accessoire-et-risque-de-mort-subite\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-12-ecg-2.png\",\"datePublished\":\"2026-04-03T14:19:44+00:00\",\"dateModified\":\"2026-04-03T14:20:26+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-12-fibrillation-auriculaire-voie-accessoire-et-risque-de-mort-subite\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-7-12-fibrillation-auriculaire-voie-accessoire-et-risque-de-mort-subite\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-12-fibrillation-auriculaire-voie-accessoire-et-risque-de-mort-subite\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-12-ecg-2.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-12-ecg-2.png\",\"width\":1732,\"height\":1293},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-12-fibrillation-auriculaire-voie-accessoire-et-risque-de-mort-subite\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 7.12: Fibrillation auriculaire, voie accessoire et risque de mort subite\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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