{"id":10240,"date":"2026-04-03T14:34:40","date_gmt":"2026-04-03T14:34:40","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10240"},"modified":"2026-04-03T14:34:40","modified_gmt":"2026-04-03T14:34:40","slug":"trace-7-17-arret-dune-tachycardie-par-reentree-intra-nodale","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-17-arret-dune-tachycardie-par-reentree-intra-nodale\/","title":{"rendered":"Trac\u00e9 7.17: Arr\u00eat d\u2019une tachycardie par r\u00e9entr\u00e9e intra-nodale"},"content":{"rendered":"","protected":false},"featured_media":10239,"template":"","ecg_case_type":[256],"language_ecgcase":[259],"class_list":["post-10240","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 7.17: Arr\u00eat d\u2019une tachycardie par r\u00e9entr\u00e9e intra-nodale","patient_description":"Jeune fille de 24 ans pr\u00e9sentant des tachycardies fr\u00e9quentes, r\u00e9guli\u00e8res c\u00e9dant spontan\u00e9\u00ad ment apr\u00e8s une trentaine de secondes","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) possible(s) sur cet ECG?","quiz_answer_1":"fibrillation auriculaire","quiz_answer_2":"tachycardie sinusale","quiz_answer_3":"flutter atrial commun","quiz_answer_4":"tachycardie par r\u00e9entr\u00e9e intra-nodale","quiz_answer_5":"tachycardie atriale 2\/1","correct_answer":["D"],"ecg_image":10239,"ecg_description":"Tachycardie r\u00e9guli\u00e8re, \u00e0 QRS fins, \u00e0 200 bpm; conduction atrio-ventriculaire 1\/1; probable activit\u00e9 atriale en fin de QRS, n\u00e9gative dans les d\u00e9rivations inf\u00e9rieures et positive en V1 et aVR;","ecg_info_box":"L\u2019aspect \u00e9lectrocardiographique de tachycardie intra-nodale typique correspond \u00e0 une tachycardie r\u00e9guli\u00e8re \u00e0 QRS fins, avec une conduction auriculo-ventriculaire 1\/1 et une activit\u00e9 atriale difficilement identifiable car superpos\u00e9e au complexe QRS. ","commentary_ecg":"Cette patiente pr\u00e9sentait des \u00e9pisodes de tachycardie par r\u00e9entr\u00e9e intra-nodale typique. Le n\u0153ud atrio-ventriculaire peut chez certains patients \u00eatre le si\u00e8ge d\u2019une dissociation longitudinale fonctionnelle en deux voies, dont les vitesses de conduction et les p\u00e9riodes r\u00e9fractaires diff\u00e8rent m\u00eame si il n\u2019est pas possible d\u2019identifier 2 structures cellulaires sp\u00e9cifiques diff\u00e9rentes. Le n\u0153ud auriculo-ventriculaire peut \u00eatre divis\u00e9 en une voie rapide ant\u00e9rieure et sup\u00e9rieure \u00e0 p\u00e9riode r\u00e9fractaire longue et une voie lente post\u00e9rieure et inf\u00e9rieure \u00e0 p\u00e9riode r\u00e9fractaire plus courte. Dans la forme commune de tachycardie par r\u00e9entr\u00e9e intra-nodale (slow-fast), de loin la plus fr\u00e9quente, la r\u00e9entr\u00e9e s\u2019\u00e9tablit entre la voie lente utilis\u00e9e dans le sens ant\u00e9rograde et la voie rapide emprunt\u00e9e dans le sens r\u00e9trograde. Le d\u00e9marrage de la tachycardie est g\u00e9n\u00e9ralement caract\u00e9ristique: \u00e0 la suite d\u2019une extrasystole atriale, la voie rapide se bloque (p\u00e9riode r\u00e9fractaire plus longue que celle de la voie lente), l\u2019influx est transmis en ant\u00e9rograde par la voie lente avec un saut de conduction, un allongement brutal de l\u2019espace PR et de l\u2019intervalle AH. La conduction \u00e0 travers la voie lente est suffisamment ralentie pour laisser le temps \u00e0 la voie rapide de sortir de sa p\u00e9riode r\u00e9fractaire et retrouver son excitabilit\u00e9. La p\u00e9n\u00e9tration r\u00e9trograde peut alors se faire dans la voie rapide et une tachycardie r\u00e9ciproque par r\u00e9entr\u00e9e peut d\u00e9buter si les p\u00e9riodes r\u00e9fractaires et les vitesses de conduction sont compatibles pour une nouvelle conduction ant\u00e9rograde par la voie lente. Chez un patient pr\u00e9sentant des tachycardies par r\u00e9entr\u00e9e intra-nodale typique, une stimulation atriale peut facilement d\u00e9clencher un \u00e9pisode, une stimulation ventriculaire beaucoup plus difficilement. Lors d\u2019une stimulation atriale \u00e0 fr\u00e9quence croissante, l\u2019espace AH s\u2019allonge progressivement puis brusquement avec un saut de conduction (augmentation de plus de 50 ms de l\u2019espace AH pour une r\u00e9duction de couplage de 10 ms du cycle de stimulation atriale) et la tachycardie d\u00e9marre avec un intervalle HA inf\u00e9rieur \u00e0 50 ms.\r\n\r\nCe type de tachycardie pr\u00e9sente certaines caract\u00e9ristiques \u00e9lectrocardiographiques: \u2022 L\u2019\u00e9lectrocardiogramme entre les crises est le plus souvent normal; \r\n\u2022 La fr\u00e9quence de la tachycardie peut varier d\u2019un patient \u00e0 l\u2019autre (entre 130 \u00e0 250 bpm); elle est g\u00e9n\u00e9ralement tr\u00e8s rapide chez l\u2019enfant (> 200 bpm) et plus lente chez les personnes \u00e2g\u00e9es (< 150 bpm) quand la conduction nodale est alt\u00e9r\u00e9e; \r\n\u2022 Les QRS sont fins dans la majorit\u00e9 des cas, m\u00eame si une aberration de conduction est possible; une alternance des QRS peut \u00eatre observ\u00e9e sans \u00eatre sp\u00e9cifique; \r\n\u2022 Conduction auriculo-ventriculaire 1\/1; les ondes P\u2019 sont r\u00e9trogrades et peuvent se superposer \u00e0 la partie terminale du QRS; elles sont alors difficilement identifiables; la primo-d\u00e9polarisation atriale est ant\u00e9ro-sup\u00e9rieure (\u00e0 l\u2019\u00e9mergence de la voie rapide); elles peuvent modifier la morphologie du QRS (en comparaison avec les complexes d\u2019origine sinusale) avec un aspect caract\u00e9ristique de pseudo-onde S dans les d\u00e9rivations inf\u00e9rieures et de pseudo-onde r\u2019 (discret retard droit) en V1 ou en aVR; plus rarement, l\u2019activit\u00e9 atriale peut \u00eatre positionn\u00e9e juste avant le QRS; certains aspects \u00e9lectrocardiographiques sont moins typiques avec un bloc de conduction ant\u00e9rograde et 2 activit\u00e9s atriales pour un ventricule;","ecg_info_post_answer":"\"\"\r\n\r\nDescription trac\u00e9<\/strong>\r\n\r\nArr\u00eat de la tachycardie apr\u00e8s injection d\u2019une ampoule d\u2019Isoptine; la modification de l\u2019aspect du QRS sur les complexes d\u2019origine sinusale confirme qu\u2019il s\u2019agissait bien d\u2019une conduction atriale r\u00e9trograde;"},"yoast_head":"\nTrac\u00e9 7.17: Arr\u00eat d\u2019une tachycardie par r\u00e9entr\u00e9e intra-nodale - 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