{"id":10270,"date":"2026-04-04T14:11:30","date_gmt":"2026-04-04T14:11:30","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10270"},"modified":"2026-04-04T14:11:30","modified_gmt":"2026-04-04T14:11:30","slug":"trace-8-10-fibrillation-ventriculaire-ischemique","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-8-10-fibrillation-ventriculaire-ischemique\/","title":{"rendered":"Trac\u00e9 8.10: Fibrillation ventriculaire isch\u00e9mique"},"content":{"rendered":"","protected":false},"featured_media":10269,"template":"","ecg_case_type":[257],"language_ecgcase":[259],"class_list":["post-10270","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 8.10: Fibrillation ventriculaire isch\u00e9mique","patient_description":"Un homme de 61 ans avec facteurs de risque (tabagisme actif et dyslipid\u00e9mie) est hospi\u00ad talis\u00e9 dans le service des soins intensifs dans le cadre d\u2019un syndrome coronarien aigu ant\u00e9\u00ad rieur; une angioplastie est r\u00e9alis\u00e9e avec pose de stent sur l\u2019art\u00e8re coronaire inter-ventric\u00ad ulaire ant\u00e9rieure 12 heures apr\u00e8s le d\u00e9but des sympt\u00f4mes; alt\u00e9ration s\u00e9v\u00e8re de la fraction d\u2019\u00e9jection ventriculaire gauche (30%); 10 jours apr\u00e8s cet \u00e9pisode, nouvelle hospitalisation dans le cadre d\u2019une mort subite r\u00e9cup\u00e9r\u00e9e","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) possible(s) sur cet ECG?","quiz_answer_1":"s\u00e9quelle de n\u00e9crose ant\u00e9rieure","quiz_answer_2":"s\u00e9quelle de n\u00e9crose inf\u00e9rieure","quiz_answer_3":"sus-d\u00e9calage persistant","quiz_answer_4":"extrasystole ventriculaire interpol\u00e9e","quiz_answer_5":"extrasystole atriale","correct_answer":["A","B","C","D"],"ecg_image":10269,"ecg_description":"Rythme sinusal; s\u00e9quelle de n\u00e9crose ant\u00e9rieure \u00e9tendue (onde Q de V1 \u00e0 V4 et dans les d\u00e9rivations inf\u00e9rieures); persistance d\u2019un sus-d\u00e9calage du segment ST qui indique une reperfusion incompl\u00e8te ou tardive; 2 extrasystoles ventriculaires interpol\u00e9es (pas de d\u00e9calage du rythme sinusal) avec couplage tr\u00e8s court (couplage de 280 ms); ces extrasystoles proviennent de la paroi septo-apicale ventriculaire gauche; les ondes P qui suivent sont conduites avec un espace PR long (conduction cach\u00e9e de l\u2019extrasystole);","ecg_info_box":"Dans les suites d\u2019une n\u00e9crose myocardique, la survie de fibres de Purkinje dans des conditions ana\u00e9robies peut favoriser la survenue d\u2019une fibrillation ventriculaire et d\u2019une mort subite. ","commentary_ecg":"Les causes de mort subite dans les suites d\u2019un infarctus du myocarde sont multifactorielles et varient en fonction du d\u00e9lai par rapport au d\u00e9but des sympt\u00f4mes. Une fibrillation ventriculaire g\u00e9n\u00e9r\u00e9e par l\u2019isch\u00e9mie est responsable de la plupart des d\u00e9c\u00e8s survenant au cours de la phase pr\u00e9-hospitali\u00e8re. L\u2019incidence d\u00e9croit ensuite r\u00e9guli\u00e8rement mais le risque reste pr\u00e9sent surtout lorsque l\u2019infarctus est \u00e9tendu et reperfus\u00e9 tardivement. Des \u00e9pisodes de fibrillation ventriculaire peuvent survenir \u00e9galement \u00e0 la phase tardive de l\u2019hospitalisation chez des patients pr\u00e9sentant une n\u00e9crose \u00e9tendue et affectant principalement le territoire ant\u00e9rieur. Une surveillance prolong\u00e9e par t\u00e9l\u00e9m\u00e9trie est donc souhaitable chez les patients ayant pr\u00e9sent\u00e9 une n\u00e9crose \u00e9tendue avec reperfusion tardive d\u2019autant plus qu\u2019il existe des extrasystoles ventriculaires fr\u00e9quentes, pr\u00e9matur\u00e9es et polymorphes.\r\n\r\nLe d\u00e9marrage d\u2019une fibrillation ventriculaire se produit le plus souvent sur une succession cycle court (extrasystole ventriculaire)-cycle long (repos compensateur)- cycle court (nouvelle extrasystole). Ce patient pr\u00e9sentait de multiples \u00e9pisodes de fibrillation ventriculaire quelques jours apr\u00e8s un \u00e9pisode d\u2019infarctus du myocarde \u00e9tendu reperfus\u00e9 tardivement en d\u00e9pit d\u2019un traitement b\u00e9tabloquant et d\u2019une s\u00e9dation temporaire. Une coronarographie de contr\u00f4le n\u2019a pas montr\u00e9 de rest\u00e9nose intra- stent. Une proc\u00e9dure d\u2019ablation a \u00e9t\u00e9 r\u00e9alis\u00e9e avec mise en \u00e9vidence d\u2019un potentiel de Purkinje au milieu de la s\u00e9quelle de n\u00e9crose. Les \u00e9pisodes d\u2019arythmie \u00e9taient d\u00e9clench\u00e9s par la survenue d\u2019extrasystoles ventriculaires provenant de fibres de Purkinje ayant surv\u00e9cu dans des conditions ana\u00e9robies. La proc\u00e9dure d\u2019ablation peut permettre de sauver une situation tr\u00e8s compromise avec \u00e9pisodes it\u00e9ratifs d\u2019arythmies ventriculaires polymorphes qui menaient quasi-syst\u00e9matiquement au d\u00e9c\u00e8s. Dans ce cadre, le r\u00f4le majeur du syst\u00e8me de Purkinje et de cellules situ\u00e9es dans la zone bordante a \u00e9t\u00e9 mis en \u00e9vidence et valid\u00e9 par la diminution ou la disparition des arythmies apr\u00e8s ablation localis\u00e9e.\r\n","ecg_info_post_answer":"<img class=\"alignnone wp-image-10383 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-493-1024x672.png\" alt=\"\" width=\"800\" height=\"525\" \/>\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10506 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-8-10-ecg2-1024x648.png\" alt=\"\" width=\"800\" height=\"506\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nMorphologie identique de l\u2019extrasystole ventriculaire; extrasystole d\u00e9clenchant une salve de tachycardie ventriculaire polymorphe non soutenue;\r\n\r\n<img class=\"alignnone wp-image-10384 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-494-1024x675.png\" alt=\"\" width=\"800\" height=\"527\" \/>\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10507 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-8-10-ecg3-1024x640.png\" alt=\"\" width=\"800\" height=\"500\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\n<img class=\"alignnone wp-image-10385 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-496-1024x647.png\" alt=\"\" width=\"800\" height=\"505\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 8.10: Fibrillation ventriculaire isch\u00e9mique - 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-8-10-fibrillation-ventriculaire-ischemique\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 8.10: Fibrillation ventriculaire isch\u00e9mique - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-8-10-fibrillation-ventriculaire-ischemique\/\" \/>\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-8-10-fibrillation-ventriculaire-ischemique\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-10-fibrillation-ventriculaire-ischemique\/\",\"name\":\"Trac\u00e9 8.10: Fibrillation ventriculaire isch\u00e9mique - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-10-fibrillation-ventriculaire-ischemique\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-10-fibrillation-ventriculaire-ischemique\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-10-ecg-2.png\",\"datePublished\":\"2026-04-04T14:11:30+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-10-fibrillation-ventriculaire-ischemique\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-8-10-fibrillation-ventriculaire-ischemique\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-10-fibrillation-ventriculaire-ischemique\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-10-ecg-2.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-10-ecg-2.png\",\"width\":1171,\"height\":780},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-10-fibrillation-ventriculaire-ischemique\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 8.10: Fibrillation ventriculaire isch\u00e9mique\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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