{"id":10260,"date":"2026-04-04T13:44:58","date_gmt":"2026-04-04T13:44:58","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10260"},"modified":"2026-04-04T13:44:58","modified_gmt":"2026-04-04T13:44:58","slug":"trace-8-6-rythme-idio-ventriculaire-accelere","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-8-6-rythme-idio-ventriculaire-accelere\/","title":{"rendered":"Trac\u00e9 8.6: Rythme idio-ventriculaire acc\u00e9l\u00e9r\u00e9"},"content":{"rendered":"","protected":false},"featured_media":10259,"template":"","ecg_case_type":[257],"language_ecgcase":[259],"class_list":["post-10260","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 8.6: Rythme idio-ventriculaire acc\u00e9l\u00e9r\u00e9","patient_description":"Jeune fille de 14 ans, pratiquant le tennis de comp\u00e9tition, sans ant\u00e9c\u00e9dent particulier; d\u00e9\u00ad couverte fortuite d\u2019une fr\u00e9quence cardiaque irr\u00e9guli\u00e8re","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) possible(s) sur cet ECG?","quiz_answer_1":"bloc de branche droit","quiz_answer_2":"rythme idio-ventriculaire acc\u00e9l\u00e9r\u00e9","quiz_answer_3":"complexes de capture","quiz_answer_4":"bloc de branche gauche","quiz_answer_5":"flutter atrial","correct_answer":["A","B","C"],"ecg_image":10259,"ecg_description":"Le trac\u00e9 initial montre un rythme sinusal avec un bloc de branche droit; l\u00e9ger ralentissement de la fr\u00e9quence sinusale et apparition d\u2019un rythme \u00e0 commande ventriculaire (QRS \u00e9largi) \u00e0 retard gauche avec dissociation auriculo-ventriculaire (activit\u00e9 atriale sinusale plus lente que le rythme ventriculaire); fr\u00e9quence ventriculaire \u00e0 80 bpm; 3 complexes de capture (complexes QRS identiques aux complexes sinusaux) \u00e0 la suite d\u2019une onde P (conduction auriculo-ventriculaire); diagnostic de rythme idio-ventriculaire acc\u00e9l\u00e9r\u00e9","ecg_info_box":"Un RIVA correspond \u00e0 un rythme d\u2019origine ventriculaire, avec un QRS large et une fr\u00e9quence inf\u00e9rieure \u00e0 120 bpm, fr\u00e9quemment observ\u00e9 dans le cadre d\u2019une reperfusion lors d\u2019un syndrome coronaire aigu.","commentary_ecg":"Cette jeune patiente sans cardiopathie pr\u00e9sentait un rythme idio-ventriculaire acc\u00e9l\u00e9r\u00e9 (RIVA). Elle n\u2019a b\u00e9n\u00e9fici\u00e9 d\u2019aucun traitement, le pronostic dans ce cadre \u00e9tant excellent et la patiente \u00e9tant asymptomatique. Le RIVA correspond \u00e0 une activit\u00e9 ventriculaire ectopique, spontan\u00e9e, peu rapide (fr\u00e9quence inf\u00e9rieure \u00e0 120 bpm), le plus souvent monomorphe, provenant du faisceau de His, du r\u00e9seau de Purkinje ou du myocarde ventriculaire indiff\u00e9renci\u00e9. Le terme de tachycardie ventriculaire lente est impropre dans la mesure o\u00f9 le rythme est souvent inf\u00e9rieur \u00e0 100 bpm, la limite d\u00e9finissant une tachycardie. Comme chez cette patiente, ce type d\u2019arythmie survient le plus souvent \u00e0 la suite d\u2019une augmentation du tonus parasympathique et d\u2019une diminution du tonus sympathique conduisant \u00e0 un ralentissement sinusal et facilitant la d\u00e9charge du foyer ectopique. Le m\u00e9canisme impliqu\u00e9 correspond \u00e0 un automatisme calcium-d\u00e9pendant qui affecte la phase 4 du potentiel d\u2019action. Le RIVA est fr\u00e9quemment observ\u00e9 dans le cadre d\u2019une reperfusion suivant un syndrome coronarien, a \u00e9t\u00e9 d\u00e9crit lors de certains surdosages en drogues (coca\u00efne) ou en m\u00e9dicaments (digitaline) mais peut \u00e9galement survenir comme dans cet exemple chez un patient jeune sans cardiopathie. Le RIVA est g\u00e9n\u00e9ralement une arythmie b\u00e9nigne et bien tol\u00e9r\u00e9e cliniquement ne n\u00e9cessitant pas de traitement. Le pronostic chez les patients jeunes sans cardiopathie est excellent. Il peut toutefois \u00eatre associ\u00e9 \u00e0 des arythmies ventriculaires plus s\u00e9v\u00e8res qui requi\u00e8rent un traitement. \r\n\r\nLes principales caract\u00e9ristiques \u00e9lectrocardiographiques sont donc plus ou moins les m\u00eames que celles d\u2019une tachycardie ventriculaire \u201clente\u201d. On retrouve: \r\n\u2022 Une fr\u00e9quence ventriculaire par d\u00e9finition inf\u00e9rieure \u00e0 120 bpm (au del\u00e0, il faut employer le terme de tachycardie ventriculaire); la fr\u00e9quence est habituellement comprise entre 60 et 110 bpm; en effet, l\u2019hyperautomatisme ventriculaire en rapport avec ce foyer ectopique induit un rythme l\u00e9g\u00e8rement sup\u00e9rieur \u00e0 la commande sinusale; \r\n\u2022 Un QRS large t\u00e9moignant de l\u2019origine ventriculaire; \r\n\u2022 La tachycardie est le plus souvent monomorphe; \r\n\u2022 La lenteur de la \u201ctachycardie\u201d favorise la survenue de complexes de capture et de fusion; \r\n\u2022 L\u2019activit\u00e9 atriale est le plus souvent dissoci\u00e9e mais une conduction r\u00e9trograde est possible; \r\n\u2022 L\u2019\u00e9pisode d\u00e9bute le plus souvent \u00e0 la faveur d\u2019un l\u00e9ger ralentissement de la fr\u00e9quence sinusale ou d\u2019une l\u00e9g\u00e8re acc\u00e9l\u00e9ration de l\u2019hyperautomatisme; \r\n\u2022 Les \u00e9pisodes c\u00e8dent le plus souvent spontan\u00e9ment avec ralentissement progressif de la fr\u00e9quence du foyer ectopique;\r\n","ecg_info_post_answer":"<img class=\"alignnone wp-image-10369 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-457-1024x695.png\" alt=\"\" width=\"800\" height=\"543\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 8.6: Rythme idio-ventriculaire acc\u00e9l\u00e9r\u00e9 - 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-8-6-rythme-idio-ventriculaire-accelere\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 8.6: Rythme idio-ventriculaire acc\u00e9l\u00e9r\u00e9 - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-8-6-rythme-idio-ventriculaire-accelere\/\" \/>\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-8-6-rythme-idio-ventriculaire-accelere\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-6-rythme-idio-ventriculaire-accelere\/\",\"name\":\"Trac\u00e9 8.6: Rythme idio-ventriculaire acc\u00e9l\u00e9r\u00e9 - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-6-rythme-idio-ventriculaire-accelere\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-6-rythme-idio-ventriculaire-accelere\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-6-ecg-2.png\",\"datePublished\":\"2026-04-04T13:44:58+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-6-rythme-idio-ventriculaire-accelere\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-8-6-rythme-idio-ventriculaire-accelere\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-6-rythme-idio-ventriculaire-accelere\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-6-ecg-2.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-6-ecg-2.png\",\"width\":1141,\"height\":769},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-6-rythme-idio-ventriculaire-accelere\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 8.6: Rythme idio-ventriculaire acc\u00e9l\u00e9r\u00e9\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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