{"id":10242,"date":"2026-04-03T14:36:42","date_gmt":"2026-04-03T14:36:42","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10242"},"modified":"2026-04-03T14:36:42","modified_gmt":"2026-04-03T14:36:42","slug":"trace-7-18-tachycardie-jonctionnelle-par-reentree-nodale-atypique","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-18-tachycardie-jonctionnelle-par-reentree-nodale-atypique\/","title":{"rendered":"Trac\u00e9 7.18: Tachycardie jonctionnelle par r\u00e9entr\u00e9e nodale atypique"},"content":{"rendered":"","protected":false},"featured_media":10241,"template":"","ecg_case_type":[256],"language_ecgcase":[259],"class_list":["post-10242","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 7.18: Tachycardie jonctionnelle par r\u00e9entr\u00e9e nodale atypique","patient_description":"Homme de 24 ans pr\u00e9sentant des tachycardies paroxystiques, \u00e0 d\u00e9but soudain et fin bru\u00ad tale, durant quelques minutes; enregistrement du d\u00e9but d\u2019une crise","quiz_question":"Concernant cet ECG, quelle(s) est(sont) la(les) r\u00e9ponse(s) vraie(s)?","quiz_answer_1":"le trac\u00e9 initial est normal","quiz_answer_2":"la tachycardie d\u00e9marre sur une extrasystole ventriculaire","quiz_answer_3":"les QRS en tachycardie sont de type retard gauche","quiz_answer_4":"les QRS en tachycardie sont de type retard droit","quiz_answer_5":"la tachycardie est de type RP\u2019 long","correct_answer":["A","B","C","E"],"ecg_image":10241,"ecg_description":"Le trac\u00e9 initial est normal (sinusal, PR normal, QRS fin); doublet d\u2019extrasystoles ventriculaires; premier cycle de la tachycardie avec QRS fin; tachycardie \u00e0 QRS large (retard gauche) avec probable conduction atriale r\u00e9trograde (ondes P\u2019 n\u00e9gative dans les d\u00e9rivations inf\u00e9rieures et positive en V1) avec RP\u2019 long (onde P\u2019 au sommet de l\u2019onde T);","ecg_info_box":"Dans une tachycardie par r\u00e9entr\u00e9e intra-nodale atypique (forme fast-slow), le circuit est invers\u00e9 par rapport \u00e0 la forme typique expliquant l\u2019aspect \u00e9lectrocardiographique: tachycardie \u00e0 QRS fins (mais aberration de conduction possible), intervalle RP\u2019 long et ondes P\u2019 n\u00e9gatives dans les d\u00e9rivations inf\u00e9rieures. ","commentary_ecg":"L\u2019exploration \u00e9lectrophysiologique a confirm\u00e9 que ce patient pr\u00e9sentait des \u00e9pisodes de tachycardie par r\u00e9entr\u00e9e intra-nodale atypique avec aberration de conduction type bloc de branche gauche. La forme atypique, dite fast-slow, correspond \u00e0 5% environ des r\u00e9entr\u00e9es intra-nodales induites au laboratoire d\u2019\u00e9lectrophysiologie; la voie rapide nodale est utilis\u00e9e dans le sens ant\u00e9rograde et la voie lente dans le sens r\u00e9trograde. Ce type de tachycardie est pr\u00e9f\u00e9rentiellement d\u00e9clench\u00e9 par une extrasystole ventriculaire ou par une stimulation rapide ventriculaire. A l\u2019inverse de la forme typique, on peut observer sur le premier cycle de la tachycardie, un saut de conduction r\u00e9trograde r\u00e9v\u00e9lant la dualit\u00e9 nodale et une onde P\u2019 situ\u00e9e \u00e0 distance du complexe QRS, la remont\u00e9e vers l\u2019oreillette se faisant par la voie lente (voie rapide r\u00e9trograde bloqu\u00e9e).\r\n\r\nDurant la tachycardie, on retrouve g\u00e9n\u00e9ralement: 1) des QRS fins m\u00eame si comme chez ce patient l\u2019existence d\u2019un bloc de branche par aberration de conduction est possible; 2) un intervalle RP\u2019 long; 3) des ondes P\u2019 le plus souvent n\u00e9gatives dans les d\u00e9rivations inf\u00e9rieures et positives en V1. L\u2019onde P\u2019 tardive se superpose ou suit l\u2019onde T du cycle pr\u00e9c\u00e9dent et peut beaucoup plus facilement \u00eatre identifi\u00e9e que dans la forme typique. Le site de primo-d\u00e9polarisation atriale se situe au niveau de la base du triangle de Koch ou dans les premiers centim\u00e8tres du sinus coronaire expliquant la n\u00e9gativit\u00e9 dans les d\u00e9rivations inf\u00e9rieures.\r\n\r\nCet aspect \u00e9lectrocardiographique particulier (tachycardie \u00e0 QRS fins, rapport 1\/1 entre oreillettes et ventricules, intervalle RP\u2019 long et ondes P\u2019 n\u00e9gatives en inf\u00e9rieur) peut parfois rendre difficile le diagnostic diff\u00e9rentiel avec une tachycardie atriale ou une tachycardie orthodromique utilisant une voie accessoire septale \u00e0 conduction r\u00e9trograde lente (tachycardies de Coumel). Le contexte clinique (tachycardies plus ou moins permanentes pour les tachycardies de Coumel versus tachycardies par crises \u00e0 d\u00e9but et fin brutales) peut diriger le diagnostic. L\u2019enregistrement du d\u00e9but et de la fin de la crise peut \u00e9galement faciliter le diagnostic (tachycardie atriale d\u00e9butant g\u00e9n\u00e9ralement sur une extrasystole atriale et finissant sur un cycle ventriculaire, r\u00e9entr\u00e9e intra-nodale atypique d\u00e9butant g\u00e9n\u00e9ralement sur une extrasystole ventriculaire et se r\u00e9duisant gr\u00e2ce aux man\u0153uvres vagales). L\u2019exploration \u00e9lectrophysiologique permet g\u00e9n\u00e9ralement d\u2019apporter une r\u00e9ponse d\u00e9finitive.","ecg_info_post_answer":"<img class=\"alignnone wp-image-10361 size-full\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-422.png\" alt=\"\" width=\"765\" height=\"345\" \/>\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10480 size-full\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-18-ecg2.png\" alt=\"\" width=\"912\" height=\"638\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nR\u00e9duction de la tachycardie apr\u00e8s un massage sino-carotidien;"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 7.18: Tachycardie jonctionnelle par r\u00e9entr\u00e9e nodale atypique - 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-7-18-tachycardie-jonctionnelle-par-reentree-nodale-atypique\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 7.18: Tachycardie jonctionnelle par r\u00e9entr\u00e9e nodale atypique - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-18-tachycardie-jonctionnelle-par-reentree-nodale-atypique\/\" \/>\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-7-18-tachycardie-jonctionnelle-par-reentree-nodale-atypique\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-18-tachycardie-jonctionnelle-par-reentree-nodale-atypique\/\",\"name\":\"Trac\u00e9 7.18: Tachycardie jonctionnelle par r\u00e9entr\u00e9e nodale atypique - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-18-tachycardie-jonctionnelle-par-reentree-nodale-atypique\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-18-tachycardie-jonctionnelle-par-reentree-nodale-atypique\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-18-ecg-2.png\",\"datePublished\":\"2026-04-03T14:36:42+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-18-tachycardie-jonctionnelle-par-reentree-nodale-atypique\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-7-18-tachycardie-jonctionnelle-par-reentree-nodale-atypique\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-18-tachycardie-jonctionnelle-par-reentree-nodale-atypique\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-18-ecg-2.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-18-ecg-2.png\",\"width\":912,\"height\":657},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-7-18-tachycardie-jonctionnelle-par-reentree-nodale-atypique\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 7.18: Tachycardie jonctionnelle par r\u00e9entr\u00e9e nodale atypique\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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