{"id":10258,"date":"2026-04-04T13:42:36","date_gmt":"2026-04-04T13:42:36","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10258"},"modified":"2026-04-04T13:42:37","modified_gmt":"2026-04-04T13:42:37","slug":"trace-8-5-tachycardie-ventriculaire-de-branche-a-branche","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-8-5-tachycardie-ventriculaire-de-branche-a-branche\/","title":{"rendered":"Trac\u00e9 8.5: Tachycardie ventriculaire de branche \u00e0 branche"},"content":{"rendered":"","protected":false},"featured_media":10257,"template":"","ecg_case_type":[257],"language_ecgcase":[259],"class_list":["post-10258","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-ventricular-tachycardia","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 8.5: Tachycardie ventriculaire de branche \u00e0 branche","patient_description":"Patient de 74 ans en fibrillation auriculaire permanente, ayant b\u00e9n\u00e9fici\u00e9 d\u2019une ablation du n\u0153ud auriculo-ventriculaire et de l\u2019implantation d\u2019un stimulateur triple chambre (sonde ventriculaire droite et sonde ventriculaire gauche); hospitalisation pour \u00e9pisode de syncope","quiz_question":"\u00c0 la vue de son histoire clinique et du trac\u00e9, quel(s) est(sont) le(s) diagnostic(s) possible(s) sur cet ECG?","quiz_answer_1":"tachycardie ventriculaire","quiz_answer_2":"tachycardie atriale avec bloc de branche gauche","quiz_answer_3":"torsade de pointes","quiz_answer_4":"fibrillation auriculaire conduite avec bloc de branche gauche","quiz_answer_5":"flutter atrial avec bloc de branche gauche","correct_answer":["A"],"ecg_image":10257,"ecg_description":"Ce trac\u00e9 montre une tachycardie, monomorphe, r\u00e9guli\u00e8re, \u00e0 155 bpm, avec un aspect tr\u00e8s \u00e9vocateur de bloc de branche gauche; l\u2019activit\u00e9 atriale est difficilement identifiable; l\u2019histoire clinique indique que ce patient a b\u00e9n\u00e9fici\u00e9 d\u2019une ablation du faisceau de His et pr\u00e9sente donc un bloc auriculo- ventriculaire ant\u00e9rograde complet; le seul diagnostic possible devant une tachycardie avec QRS spontan\u00e9s (pas de stimulation ventriculaire) est donc une tachycardie ventriculaire; l\u2019histoire clinique peut parfois influencer l\u2019interpr\u00e9tation d\u2019un trac\u00e9 (un ant\u00e9c\u00e9dent d\u2019infarctus \u00e9voque une tachycardie ventriculaire mais sans en garantir le diagnostic) mais peut parfois permettre un diagnostic de certitude (comme dans ce cas quand il existe un bloc auriculo-ventriculaire complet); probable tachycardie par r\u00e9entr\u00e9e de branche \u00e0 branche; ","ecg_info_box":"Une r\u00e9entr\u00e9e de branche \u00e0 branche survient pr\u00e9f\u00e9rentiellement chez des patients insuffisants cardiaques avec fr\u00e9quemment un aspect en tachycardie de bloc de branche gauche.","commentary_ecg":"Une r\u00e9entr\u00e9e de branche \u00e0 branche est une forme particuli\u00e8re de tachycardie ventriculaire r\u00e9sultant d\u2019une macror\u00e9entr\u00e9e entre les 2 branches. Ce type de tachycardie repr\u00e9sente un pourcentage important (de l\u2019ordre de 20 \u00e0 40%) des tachycardies ventriculaires observ\u00e9es chez les patients avec myocardiopathie idiopathique non isch\u00e9mique. Un certain nombre de cas ont \u00e9t\u00e9 \u00e9galement d\u00e9crits dans le cadre de myocardiopathies valvulaires ou isch\u00e9miques, chez des patients pr\u00e9sentant une myotonie et chez quelques patients sans cardiopathie. La survenue d\u2019une lipothymie, syncope ou mort subite est fr\u00e9quente car la tachycardie est souvent rapide et se produit sur un myocarde alt\u00e9r\u00e9. La branche droite constitue la voie ant\u00e9rograde dans une majorit\u00e9 des cas, un des fascicules (ant\u00e9rieur ou post\u00e9rieur) de la branche gauche constituant la voie r\u00e9trograde expliquant l\u2019aspect de bloc de branche gauche. Le circuit inverse (aspect de bloc de branche droit) est plus rare. \r\n\r\nL\u2019initiation de la r\u00e9entr\u00e9e se produit quand un complexe atrial ou ventriculaire pr\u00e9matur\u00e9 est bloqu\u00e9 dans une des branches, conduit dans l\u2019autre dans le sens ant\u00e9rograde puis p\u00e9n\u00e8tre en r\u00e9trograde la branche initialement bloqu\u00e9e induisant une tachycardie par r\u00e9entr\u00e9e soutenue. L\u2019\u00e9lectrocardiogramme en rythme sinusal retrouve fr\u00e9quemment un bloc auriculo-ventriculaire du premier degr\u00e9, un trouble de conduction distal asp\u00e9cifique, un bloc de branche gauche \u00e9tant plus rare. Le pr\u00e9requis pour la survenue d\u2019une r\u00e9entr\u00e9e de branche \u00e0 branche est l\u2019existence d\u2019un d\u00e9lai de conduction au niveau du syst\u00e8me de His-Purkinje se traduisant par la mesure d\u2019un intervalle HV prolong\u00e9 (80 ms en moyenne). Chez ce patient, l\u2019ablation du n\u0153ud auriculo-ventriculaire ne permet pas d\u2019analyser la s\u00e9quence d\u2019activation ventriculaire spontan\u00e9e. Les traitements antiarythmiques sont rarement efficaces dans ce cadre. L\u2019ablation de la branche droite permet souvent de r\u00e9gler le probl\u00e8me, m\u00eame si un d\u00e9fibrillateur implantable reste indiqu\u00e9 du fait de la dysfonction ventriculaire gauche. ","ecg_info_post_answer":"\"\"\r\n\r\n \r\n\r\n \r\n\r\n \r\n\r\n\"\"\r\n\r\nDescription trac\u00e9<\/strong>\r\n\r\nApr\u00e8s r\u00e9duction, enregistrement du trac\u00e9 qui montre une fibrillation auriculaire peu volt\u00e9e, une stimulation biventriculaire (QRS fins, n\u00e9gatif en DI et positif en V1); existence d\u2019un triplet ventriculaire polymorphe t\u00e9moin du contexte arythmog\u00e8ne"},"yoast_head":"\nTrac\u00e9 8.5: Tachycardie ventriculaire de branche \u00e0 branche - 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-8-5-tachycardie-ventriculaire-de-branche-a-branche\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 8.5: Tachycardie ventriculaire de branche \u00e0 branche - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-8-5-tachycardie-ventriculaire-de-branche-a-branche\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-04T13:42:37+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-8-5-tachycardie-ventriculaire-de-branche-a-branche\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-5-tachycardie-ventriculaire-de-branche-a-branche\/\",\"name\":\"Trac\u00e9 8.5: Tachycardie ventriculaire de branche \u00e0 branche - 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