{"id":10238,"date":"2026-04-03T14:32:26","date_gmt":"2026-04-03T14:32:26","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10238"},"modified":"2026-04-03T14:32:26","modified_gmt":"2026-04-03T14:32:26","slug":"trace-7-16-tachycardie-par-reentree-intra-nodale-typique","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-16-tachycardie-par-reentree-intra-nodale-typique\/","title":{"rendered":"Trac\u00e9 7.16: Tachycardie par r\u00e9entr\u00e9e intra-nodale typique"},"content":{"rendered":"","protected":false},"featured_media":10237,"template":"","ecg_case_type":[256],"language_ecgcase":[259],"class_list":["post-10238","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 7.16: Tachycardie par r\u00e9entr\u00e9e intra-nodale typique","patient_description":"Patiente de 54 ans pr\u00e9sentant un long pass\u00e9 de tachycardies bien tol\u00e9r\u00e9es et c\u00e9dant spon\u00ad tan\u00e9ment au bout de 2 \u00e0 3 minutes; depuis quelques temps, crises quotidiennes de dur\u00e9e plus prolong\u00e9e","quiz_question":"Concernant cet ECG, quelle(s) est(sont) la(les) r\u00e9ponse(s) vraie(s)?","quiz_answer_1":"rythme initialement sinusal","quiz_answer_2":"l\u2019arythmie d\u00e9marre sur une extrasystole auriculaire","quiz_answer_3":"allongement brutal de l\u2019intervalle PR sur le premier cycle de la tachycardie","quiz_answer_4":"durant la tachycardie, pr\u00e9sence d\u2019une aberration de conduction","quiz_answer_5":"probable fibrillation auriculaire","correct_answer":["A","B","C"],"ecg_image":10237,"ecg_description":"Initialement le rythme est sinusal; la tachycardie d\u00e9marre sur une extrasystole atriale conduite au ventricule avec une augmentation brutale de l\u2019espace PR; tachycardie r\u00e9guli\u00e8re \u00e0 QRS fins, identiques aux complexes d\u2019origine sinusale; difficult\u00e9 \u00e0 diff\u00e9rencier l\u2019activit\u00e9 atriale (lors de la tachycardie, modification de l\u2019aspect de la partie pr\u00e9c\u00e9dant le QRS mais \u00e9galement l\u00e9g\u00e8re modification de la partie terminale du QRS par rapport aux complexes d\u2019origine sinusale);\u00a0\r\n","ecg_info_box":"Le d\u00e9marrage d\u2019une tachycardie par r\u00e9entr\u00e9e intra-nodale typique (slow-fast) est g\u00e9n\u00e9ralement caract\u00e9ristique: \u00e0 la suite d\u2019une extrasystole atriale, la voie rapide se bloque, l\u2019influx est transmis en ant\u00e9rograde par la voie lente avec un saut de conduction et un allongement brutal de l\u2019espace PR. Une stimulation atriale d\u00e9clenche facilement ce type de tachycardie, une stimulation ventriculaire beaucoup plus difficilement. ","commentary_ecg":"Certains \u00e9l\u00e9ments de ce trac\u00e9 concernant le d\u00e9marrage, l\u2019entretien et l\u2019arr\u00eat de la tachycardie (d\u00e9marrage sur une extrasystole atriale avec allongement brutal de l\u2019intervalle PR, tachycardie r\u00e9guli\u00e8re \u00e0 QRS fins, activit\u00e9 atriale en 1\/1 situ\u00e9e en fin du QRS, arr\u00eat par injection d\u2019Ad\u00e9nosine) sont \u00e9vocateurs d\u2019une r\u00e9entr\u00e9e intra-nodale; ce diagnostic a \u00e9t\u00e9 confirm\u00e9 lors d\u2019une exploration \u00e9lectrophysiologique. \r\n\r\nLes tachycardies par r\u00e9entr\u00e9e intra-nodale sont les plus fr\u00e9quentes des tachycardies jonctionnelles et surviennent g\u00e9n\u00e9ralement chez des patients jeunes sans cardiopathie. Elles peuvent survenir \u00e0 tous les \u00e2ges de la vie, du nourrisson \u00e0 la personne \u00e2g\u00e9e, l\u2019histoire clinique retrouvant souvent un long pass\u00e9 de crises de dur\u00e9es variables, c\u00e9dant spontan\u00e9ment ou par des man\u0153uvres vagales. \r\n\r\nLa pr\u00e9sentation clinique des crises est relativement st\u00e9r\u00e9otyp\u00e9e (description correspondant aux tachycardies d\u00e9crites par Bouveret): les tachycardies sont r\u00e9guli\u00e8res, d\u2019installation soudaine (le patient sait de fa\u00e7on pr\u00e9cise le moment o\u00f9 la crise a commenc\u00e9) et de fin brutale avec souvent une sensation de bien-\u00eatre; la dur\u00e9e des crises varie d\u2019un patient \u00e0 l\u2019autre de quelques minutes \u00e0 plusieurs heures; dans la grande majorit\u00e9 des cas, la tol\u00e9rance fonctionnelle est bonne car ces tachycardies surviennent majoritairement chez des patients avec c\u0153ur sain. En fonction du degr\u00e9 d\u2019acc\u00e9l\u00e9ration de la fr\u00e9quence cardiaque, la crise peut \u00eatre plus ou moins symptomatique avec description fr\u00e9quente de palpitations, d\u2019une anxi\u00e9t\u00e9 et\/ou d\u2019une dyspn\u00e9e, et plus rarement de douleurs thoraciques, de lipothymies ou de syncopes quand la fr\u00e9quence est tr\u00e8s rapide. \r\n\r\nDans la mesure o\u00f9 les crises surviennent en l\u2019absence de cardiopathie sous-jacente, elles sont consid\u00e9r\u00e9es comme b\u00e9nignes m\u00eame si les tachycardies peuvent \u00eatre invalidantes quand elles sont fr\u00e9quentes, tr\u00e8s rapides et ne c\u00e8dent pas avec les man\u0153uvres vagales usuelles. Le principal risque \u00e9volutif, en dehors du nombre et de la dur\u00e9e des crises de tachycardie qui ont tendance \u00e0 augmenter, est l\u2019apparition d\u2019une fibrillation auriculaire dont l\u2019incidence s\u2019accroit avec l\u2019\u00e2ge. \r\n\r\nLa r\u00e9duction de la crise peut \u00eatre obtenue gr\u00e2ce \u00e0 la r\u00e9alisation de man\u0153uvres vagales simples (Valsalva, d\u00e9glutition prolong\u00e9e, compression sino-carotidienne, compression oculaire \u00e0 \u00e9viter car douloureuse et traumatisante) qui sont efficaces pr\u00e9f\u00e9rentiellement en d\u00e9but de crise et que le patient peut r\u00e9aliser lui-m\u00eame. Si ces man\u0153uvres sont inefficaces, une injection d\u2019Ad\u00e9nosine ou de V\u00e9rapamil peut \u00eatre r\u00e9alis\u00e9e sous contr\u00f4le \u00e9lectrocardiographique, l\u2019existence \u00e0 la r\u00e9duction d\u2019une pause pouvant \u00eatre prolong\u00e9e \u00e9tant relativement fr\u00e9quente. Quand exceptionnellement, le traitement m\u00e9dical est inefficace, une stimulation atriale peut \u00eatre propos\u00e9e. \r\n\r\nUn traitement pr\u00e9ventif au long cours (V\u00e9rapamil, b\u00e9tabloquants, antiarythmiques de classe IC) n\u2019est propos\u00e9 que quand les crises sont fr\u00e9quentes et invalidantes. L\u2019ablation de la voie lente peut permettre de supprimer les crises au prix d\u2019un risque faible mais non nul de survenue d\u2019un bloc auriculo-ventriculaire complet. ","ecg_info_post_answer":"\"\"\r\n\r\nDescription trac\u00e9<\/strong>\r\n\r\nInterruption de la tachycardie apr\u00e8s injection d\u2019une ampoule d\u2019Ad\u00e9nosine en flash; reprise d\u2019un rythme sinusal avec espace PR l\u00e9g\u00e8rement allong\u00e9; la comparaison du complexe QRS en tachycardie et en rythme sinusal montre une diff\u00e9rence en fin de QRS-d\u00e9but du segment ST bien visible en aVR et de V1 \u00e0 V4 laissant supposer la pr\u00e9sence d\u2019une activit\u00e9 atriale coll\u00e9e au QRS lors de la tachycardie;"},"yoast_head":"\nTrac\u00e9 7.16: Tachycardie par r\u00e9entr\u00e9e intra-nodale typique - 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-7-16-tachycardie-par-reentree-intra-nodale-typique\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 7.16: Tachycardie par r\u00e9entr\u00e9e intra-nodale typique - 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