{"id":10273,"date":"2026-04-04T14:15:29","date_gmt":"2026-04-04T14:15:29","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10273"},"modified":"2026-04-04T14:15:29","modified_gmt":"2026-04-04T14:15:29","slug":"trace-8-11-fibrillation-ventriculaire-idiopathique","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-8-11-fibrillation-ventriculaire-idiopathique\/","title":{"rendered":"Trac\u00e9 8.11: Fibrillation ventriculaire idiopathique"},"content":{"rendered":"","protected":false},"featured_media":10272,"template":"","ecg_case_type":[257],"language_ecgcase":[259],"class_list":["post-10273","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 8.11: Fibrillation ventriculaire idiopathique","patient_description":"Femme de 57 ans sans ant\u00e9c\u00e9dent cardiovasculaire notable, hospitalis\u00e9e dans le cadre de syncopes s\u00e9v\u00e8res r\u00e9p\u00e9t\u00e9es depuis 15 jours; enregistrement du trac\u00e9 en continu; enregistre\u00ad ment lors d\u2019un \u00e9pisode de syncope","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) possible(s) sur cet ECG?","quiz_answer_1":"rythme de base sinusal","quiz_answer_2":"s\u00e9quelle de n\u00e9crose inf\u00e9rieure","quiz_answer_3":"salve de tachycardie ventriculaire polymorphe","quiz_answer_4":"torsade de pointe sur QT long","quiz_answer_5":"fibrillation atriale sur voie accessoire","correct_answer":["A","C"],"ecg_image":10272,"ecg_description":"Rythme sinusal, intervalle PR limite; extrasystole ventriculaire d\u00e9clenchant une salve de tachycardie ventriculaire, tr\u00e8s rapide, irr\u00e9guli\u00e8re, polymorphe, se r\u00e9duisant spontan\u00e9ment apr\u00e8s une quinzaine de complexes; reprise du rythme sinusal; ce court \u00e9pisode \u00e9tait responsable d\u2019une lipothymie;","ecg_info_box":"La fibrillation ventriculaire correspond \u00e0 une activit\u00e9 \u00e9lectrique ventriculaire compl\u00e8tement d\u00e9sorganis\u00e9e chaotique et incoordonn\u00e9e se traduisant sur l\u2019ECG par une succession totalement irr\u00e9guli\u00e8re \u00e0 haute fr\u00e9quence d\u2019accidents de dur\u00e9e et d\u2019amplitude variables parmi lesquels on ne reconnait plus ni ondes P, ni complexes QRS, ni ondes T.","commentary_ecg":"La fibrillation ventriculaire est un mode d\u2019activit\u00e9 \u00e9lectrique ventriculaire compl\u00e8tement d\u00e9sorganis\u00e9e chaotique et incoordonn\u00e9e, avec disparition de l\u2019alternance entre systoles et diastoles \u00e9lectriques remplac\u00e9es par des mouvements faibles et vermiculaires de la paroi ventriculaire totalement d\u00e9nu\u00e9s d\u2019efficacit\u00e9 h\u00e9modynamique et conduisant \u00e0 un arr\u00eat circulatoire. Sur l\u2019\u00e9lectrocardiogramme de surface 12-d\u00e9rivations (rarement enregistr\u00e9 dans ce cadre au vu de l\u2019urgence vitale), on observe une succession totalement irr\u00e9guli\u00e8re \u00e0 haute fr\u00e9quence d\u2019accidents de dur\u00e9e et d\u2019amplitude variables parmi lesquels on ne reconnait plus ni ondes P, ni complexes QRS, ni ondes T. L\u2019aspect de cette tr\u00e9mulation \u00e9lectrique \u00e9volue g\u00e9n\u00e9ralement dans le temps (sur un d\u00e9lai de quelques secondes \u00e0 2 ou 3 minutes), passant en l\u2019absence de traitement, d\u2019une forme dite tonique \u00e0 large maille avec oscillations de grande amplitude \u00e0 une forme dite atonique \u00e0 petite maille qui pr\u00e9c\u00e8de le trac\u00e9 plat agonique. Le d\u00e9marrage de la fibrillation ventriculaire peut \u00eatre abrupt (fibrillation ventriculaire d\u2019embl\u00e9e) d\u00e9clench\u00e9 par une extrasystole ventriculaire g\u00e9n\u00e9ralement pr\u00e9coce ou survenir apr\u00e8s une dur\u00e9e plus ou moins prolong\u00e9e de tachycardie ventriculaire monomorphe ou polymorphe. Une fibrillation ventriculaire correspond \u00e0 de multiples circuits de micro-r\u00e9entr\u00e9es qui se d\u00e9veloppent, se propagent et interf\u00e8rent les uns avec les autres au c\u0153ur d\u2019une masse myocardique critique suffisante. Le d\u00e9clenchement de cette arythmie ventriculaire anarchique n\u00e9cessite une stimulation du myocarde ventriculaire au moment de sa phase vuln\u00e9rable (le plus souvent une ou plusieurs extrasystoles) et une inhomog\u00e9n\u00e9it\u00e9 en termes de p\u00e9riodes r\u00e9fractaires et de vitesses de conduction des fibres myocardiques. Ce trouble du rythme s\u2019auto-entretient ce qui explique son caract\u00e8re g\u00e9n\u00e9ralement irr\u00e9versible et la survenue d\u2019une mort subite en l\u2019absence de choc \u00e9lectrique, la seule th\u00e9rapeutique permettant le retour d\u2019une h\u00e9modynamique efficace. Elle occasionne rarement une syncope car les r\u00e9ductions spontan\u00e9es sont exceptionnelles (sauf apr\u00e8s plusieurs minutes laissant place \u00e0 une asystolie).\r\n\r\nLes particularit\u00e9s chez cette patiente r\u00e9sident dans le fait que les \u00e9pisodes de fibrillation ventriculaire surviennent en l\u2019absence de tout contexte identifiable et qu\u2019ils se r\u00e9duisent spontan\u00e9ment occasionnant une symptomatologie type syncopes \u00e0 r\u00e9p\u00e9tition. On utilise le terme de fibrillation idiopathique quand elle se produit sur c\u0153ur anatomiquement sain, en l\u2019absence de cardiopathie sous-jacente diagnostiqu\u00e9e apr\u00e8s un bilan exhaustif, en l\u2019absence de toute anomalie fonctionnelle ou structurale, en l\u2019absence d\u2019arguments pour diff\u00e9rentes canalopathies (syndrome de Brugada, QT long ...) ou d\u2019anomalies \u00e9lectrophysiologiques majeures momentan\u00e9es (isch\u00e9mie, troubles m\u00e9taboliques ou \u00e9lectrolytiques, effet secondaire m\u00e9dicamenteux). Il s\u2019agit donc d\u2019un diagnostic d\u2019exclusion. Les fibrillations ventriculaires idiopathiques repr\u00e9sentent moins de 5% des fibrillations totales et surviennent principalement chez certains patients jeunes de moins de 50 ans. Il est probable que dans le futur, avec le d\u00e9veloppement de nouvelles techniques d\u2019imagerie et de cartographie g\u00e9n\u00e9tique, une explication puisse \u00eatre trouv\u00e9e pour tout ou partie des cas d\u00e9finis aujourd\u2019hui comme idiopathiques.\r\n\r\nCette patiente a b\u00e9n\u00e9fici\u00e9 de l\u2019implantation d\u2019un d\u00e9fibrillateur, le risque de mort subite paraissant majeur.\r\n","ecg_info_post_answer":"<img class=\"alignnone wp-image-10386 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-501-1024x652.png\" alt=\"\" width=\"800\" height=\"509\" \/>\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10508 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-8-11-ecg2-scaled-e1775312023137-1024x610.png\" alt=\"\" width=\"800\" height=\"477\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nTrac\u00e9 enregistr\u00e9 quelques secondes apr\u00e8s le premier; extrasystole ventriculaire identique (provenant de la base du ventricule gauche), moyennement pr\u00e9coce, faisant d\u00e9g\u00e9n\u00e9rer le rythme en une tachycardie polymorphe, tr\u00e8s rapide, irr\u00e9guli\u00e8re, correspondant \u00e0 une fibrillation ventriculaire \u00e0 large maille;\r\n\r\n<img class=\"alignnone wp-image-10387 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-502-1024x578.png\" alt=\"\" width=\"800\" height=\"452\" \/>\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10509 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-8-11-ecg3-scaled-e1775312097557-1024x649.png\" alt=\"\" width=\"800\" height=\"507\" \/>\r\n\r\n<strong>Description trac\u00e9<\/strong>\r\n\r\nFin de l\u2019\u00e9pisode; la fibrillation se r\u00e9duit spontan\u00e9ment apr\u00e8s une quinzaine de secondes;\r\n\r\n<img class=\"alignnone wp-image-10388 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-504-1024x555.png\" alt=\"\" width=\"800\" height=\"434\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 8.11: Fibrillation ventriculaire idiopathique - 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-8-11-fibrillation-ventriculaire-idiopathique\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 8.11: Fibrillation ventriculaire idiopathique - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-8-11-fibrillation-ventriculaire-idiopathique\/\" \/>\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-8-11-fibrillation-ventriculaire-idiopathique\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-11-fibrillation-ventriculaire-idiopathique\/\",\"name\":\"Trac\u00e9 8.11: Fibrillation ventriculaire idiopathique - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-11-fibrillation-ventriculaire-idiopathique\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-11-fibrillation-ventriculaire-idiopathique\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-11-ecg-5-scaled-e1775311898806.png\",\"datePublished\":\"2026-04-04T14:15:29+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-11-fibrillation-ventriculaire-idiopathique\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-8-11-fibrillation-ventriculaire-idiopathique\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-11-fibrillation-ventriculaire-idiopathique\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-11-ecg-5-scaled-e1775311898806.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-11-ecg-5-scaled-e1775311898806.png\",\"width\":2560,\"height\":1519},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-11-fibrillation-ventriculaire-idiopathique\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 8.11: Fibrillation ventriculaire idiopathique\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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