{"id":10231,"date":"2026-04-03T14:25:24","date_gmt":"2026-04-03T14:25:24","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10231"},"modified":"2026-04-03T14:25:24","modified_gmt":"2026-04-03T14:25:24","slug":"trace-7-14-maladie-debstein-pre-excitation-et-fibrillation-auriculaire","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-14-maladie-debstein-pre-excitation-et-fibrillation-auriculaire\/","title":{"rendered":"Trac\u00e9 7.14: Maladie d\u2019ebstein, pr\u00e9-excitation et fibrillation auriculaire"},"content":{"rendered":"","protected":false},"featured_media":10230,"template":"","ecg_case_type":[256],"language_ecgcase":[259],"class_list":["post-10231","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 7.14: Maladie d\u2019ebstein, pr\u00e9-excitation et fibrillation auriculaire","patient_description":"Homme de 28 ans pr\u00e9sentant une maladie d\u2019Ebstein avec pr\u00e9-excitation; il a b\u00e9n\u00e9fici\u00e9, \u00e0 l\u2019\u00e2ge de 11 ans, d\u2019une premi\u00e8re proc\u00e9dure d\u2019ablation d\u2019une voie accessoire post\u00e9ro-lat\u00e9rale droite responsable de palpitations ; hospitalisation en urgence pour palpitations brutales avec h\u00e9modynamique instable ; l\u2019injection de 2 ampoules d\u2019amiodarone intraveineuse per\u00ad met une r\u00e9duction de l\u2019arythmie avec stabilisation clinique","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) possible(s) sur cet ECG?","quiz_answer_1":"tachycardie ventriculaire","quiz_answer_2":"voie accessoire + fibrillation auriculaire","quiz_answer_3":"fibrillation ventriculaire","quiz_answer_4":"torsade de pointes","quiz_answer_5":"flutter atrial","correct_answer":["B"],"ecg_image":10230,"ecg_description":"ECG enregistr\u00e9 \u00e0 l\u2019arriv\u00e9e; rythme ventriculaire rapide (RR le plus court mesur\u00e9 \u00e0 230 ms) et irr\u00e9gulier ; aspect en accord\u00e9on caract\u00e9ristique d\u2019une fibrillation auriculaire sur pr\u00e9-excitation ventriculaire ; quand les QRS sont pr\u00e9-excit\u00e9s au maximum (QRS les plus larges), on observe un axe gauche, un aspect QS en V1 et une transition entre V1 et V2 ; l\u2019aspect \u00e9lectrocardiographique est caract\u00e9ristique d\u2019une fibrillation auriculaire sur voie accessoire ;","ecg_info_box":"Les patients avec maladie d\u2019Ebstein sont expos\u00e9s \u00e0 un risque augment\u00e9 de mort subite devant la pr\u00e9sence d\u2019une ou plusieurs voies accessoires mais \u00e9galement devant une incidence accrue d\u2019arythmies atriales. ","commentary_ecg":"Les patients avec maladie d\u2019Ebstein pr\u00e9sentent fr\u00e9quemment non seulement une ou plusieurs voies accessoires mais \u00e9galement une incidence accrue d\u2019arythmies atriales en rapport avec une fuite tricuspide, avec la dilatation majeure de l\u2019oreillette droite ou avec une \u00e9ventuelle cicatrice chirurgicale. L\u2019association entre une fibrillation auriculaire et une voie accessoire perm\u00e9able peut \u00eatre particuli\u00e8rement dangereuse. \r\n\r\nLe traitement de la voie accessoire d\u00e9pend de l\u2019existence d\u2019arythmies, de leur fr\u00e9quence, de leur s\u00e9v\u00e9rit\u00e9 et du degr\u00e9 de perm\u00e9abilit\u00e9 de la voie accessoire. Un traitement par anti-arythmique de classe IC peut \u00eatre propos\u00e9. La limite s\u00e9parant patients \u00e0 bas risque pouvant b\u00e9n\u00e9ficier uniquement d\u2019un traitement m\u00e9dical et patients \u00e0 haut risque n\u00e9cessitant une ablation de la voie accessoire est difficile \u00e0 d\u00e9finir. Pour ce patient pr\u00e9sentant des \u00e9pisodes de fibrillation auriculaire avec conduction rapide par la voie accessoire entrainant un \u00e9tat h\u00e9modynamique pr\u00e9caire, l\u2019ablation parait indispensable. Chez les patients peu ou pas symptomatiques, l\u2019attitude th\u00e9rapeutique \u00e0 privil\u00e9gier est plus d\u00e9battue. Le caract\u00e8re b\u00e9nin ou malin doit toutefois probablement \u00eatre syst\u00e9matiquement \u00e9valu\u00e9.\r\n\r\nLa proc\u00e9dure d\u2019ablation peut \u00eatre techniquement difficile avec un taux de succ\u00e8s moindre que pour une voie accessoire sur c\u0153ur sain. En effet, 1) comme expliqu\u00e9 pr\u00e9c\u00e9demment, un m\u00eame patient peut pr\u00e9senter de multiples voies ; ces voies accessoires peuvent \u00eatre longues et de diam\u00e8tre important; 2) la d\u00e9marcation entre myocarde auriculaire et myocarde ventriculaire est moins nette et la pr\u00e9sence au niveau de la partie atriale de signaux anormaux, fragment\u00e9s et non reli\u00e9s \u00e0 la voie accessoire est fr\u00e9quemment observ\u00e9e; 3) l\u2019oreillette droite est souvent tr\u00e8s dilat\u00e9e rendant difficile la manipulation de cath\u00e9ters et n\u00e9cessitant l\u2019utilisation de gaines avec de grandes courbes; 4) l\u2019obtention de temp\u00e9ratures \u00e9lev\u00e9es est parfois difficile; 5) l\u2019agressivit\u00e9 des l\u00e9sions doit parfois \u00eatre limit\u00e9e, en raison de la description de l\u00e9sions de l\u2019art\u00e8re coronaire droite.\r\n","ecg_info_post_answer":"<img class=\"alignnone wp-image-10475 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-14-ecg2-1024x679.jpeg\" alt=\"\" width=\"800\" height=\"530\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nCe patient a b\u00e9n\u00e9fici\u00e9 d\u2019une proc\u00e9dure d\u2019ablation d\u2019une voie accessoire post\u00e9ro-lat\u00e9rale droite avec succ\u00e8s; aspect caract\u00e9ristique d\u2019une maladie d\u2019Ebstein : rythme sinusal, hypertrophie auriculaire droite, espace PR allong\u00e9 (bloc auriculo-ventriculaire du premier degr\u00e9 en rapport avec un temps de d\u00e9polarisation auriculaire droit prolong\u00e9) ; bloc de branche droit incomplet ;"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 7.14: Maladie d\u2019ebstein, pr\u00e9-excitation et fibrillation auriculaire - 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-7-14-maladie-debstein-pre-excitation-et-fibrillation-auriculaire\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 7.14: Maladie d\u2019ebstein, pr\u00e9-excitation et fibrillation auriculaire - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-14-maladie-debstein-pre-excitation-et-fibrillation-auriculaire\/\" \/>\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-7-14-maladie-debstein-pre-excitation-et-fibrillation-auriculaire\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-14-maladie-debstein-pre-excitation-et-fibrillation-auriculaire\/\",\"name\":\"Trac\u00e9 7.14: Maladie d\u2019ebstein, pr\u00e9-excitation et fibrillation auriculaire - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-14-maladie-debstein-pre-excitation-et-fibrillation-auriculaire\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-14-maladie-debstein-pre-excitation-et-fibrillation-auriculaire\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-14-ecg-4-scaled.jpeg\",\"datePublished\":\"2026-04-03T14:25:24+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-14-maladie-debstein-pre-excitation-et-fibrillation-auriculaire\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-7-14-maladie-debstein-pre-excitation-et-fibrillation-auriculaire\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-14-maladie-debstein-pre-excitation-et-fibrillation-auriculaire\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-14-ecg-4-scaled.jpeg\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-14-ecg-4-scaled.jpeg\",\"width\":2560,\"height\":1386},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-14-maladie-debstein-pre-excitation-et-fibrillation-auriculaire\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 7.14: Maladie d\u2019ebstein, pr\u00e9-excitation et fibrillation auriculaire\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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