{"id":10277,"date":"2026-04-04T14:20:49","date_gmt":"2026-04-04T14:20:49","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10277"},"modified":"2026-04-04T14:20:50","modified_gmt":"2026-04-04T14:20:50","slug":"trace-8-13-torsades-de-pointes","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-8-13-torsades-de-pointes\/","title":{"rendered":"Trac\u00e9 8.13: Torsades de pointes"},"content":{"rendered":"","protected":false},"featured_media":10276,"template":"","ecg_case_type":[257],"language_ecgcase":[259],"class_list":["post-10277","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 8.13: Torsades de pointes","patient_description":"Homme de 48 ans, avec ant\u00e9c\u00e9dent d\u2019infarctus inf\u00e9rieur; hospitalisation \u00e0 la suite de la sur\u00ad venue de 2 \u00e9pisodes de syncope traumatisante; enregistrement de ce trac\u00e9","quiz_question":"Sur ces trac\u00e9s de Holter-ECG, on retrouve:","quiz_answer_1":"un allongement de l\u2019intervalle QT","quiz_answer_2":"des extrasystoles ventriculaires","quiz_answer_3":"une torsades de pointes","quiz_answer_4":"une fibrillation auriculaire sur voie accessoire","quiz_answer_5":"une tachycardie par r\u00e9entr\u00e9e intranodale","correct_answer":["A","B","C"],"ecg_image":10276,"ecg_description":"Sur ces trac\u00e9s Holter, on retrouve les diff\u00e9rents \u00e9l\u00e9ments d\u2019une torsade de pointes: 1) un QT long sur le rythme sinusal; 2) des extrasystoles ventriculaires peu pr\u00e9matur\u00e9es mais tombant sur l\u2019onde T du fait de sa dur\u00e9e prolong\u00e9e; extrasystoles en doublets ou en salves; 3) une tachycardie d\u00e9marrant sur une extrasystole; tachycardie \u00e0 QRS large entre 170 et 200 bpm; tachycardie irr\u00e9guli\u00e8re polymorphe avec rotation des complexes QRS autour de la ligne de base \u201ciso\u00e9lectrique\u201d avec changement d\u2019axe (QRS positifs, puis n\u00e9gatifs, puis positifs) tous les 20 complexes ventriculaires environ; 4) une r\u00e9duction spontan\u00e9e de l\u2019\u00e9pisode expliquant la survenue d\u2019une syncope et non pas d\u2019une mort subite","ecg_info_box":"","commentary_ecg":"Une torsade de pointes correspond \u00e0 une tachycardie interm\u00e9diaire entre une fibrillation ventriculaire et une tachycardie ventriculaire avec une pr\u00e9sentation clinique et \u00e9lectrocardiographique caract\u00e9ristique:\r\n\r\n1) circonstances de survenue: entre les acc\u00e8s de tachycardie, on observe le plus souvent une bradycardie et des anomalies importantes de la repolarisation traduites par la mise en \u00e9vidence d\u2019un intervalle QT allong\u00e9. Les diverses \u00e9tiologies de torsades de pointes ont donc pour point commun soit d\u2019allonger l\u2019intervalle QT, soit de ralentir la fr\u00e9quence cardiaque, soit les 2 en m\u00eame temps. Les \u00e9tiologies les plus fr\u00e9quemment observ\u00e9es sont le bloc auriculo- ventriculaire (10 \u00e0 15% des syncopes type Adam Stokes observ\u00e9es dans ce cadre sont en rapport avec une torsade de pointes), la pause post-r\u00e9ductionnelle d\u2019une fibrillation auriculaire (surtout chez les patients trait\u00e9s par diur\u00e9tiques et\/ou amiodarone), l\u2019hypokali\u00e9mie, une origine iatrog\u00e8ne (liste des m\u00e9dicaments allongeant le QT), l\u2019existence d\u2019un QT long cong\u00e9nital. Plusieurs causes favorisantes peuvent \u00eatre associ\u00e9es comme l\u2019addition d\u2019une hypokali\u00e9mie et d\u2019un traitement allongeant le QT.\r\n\r\n2) un facteur d\u00e9clenchant: l\u2019\u00e9pisode de tachycardie est annonc\u00e9 et d\u00e9clench\u00e9 par la survenue d\u2019extrasystoles ventriculaires pas forc\u00e9ment tr\u00e8s pr\u00e9coces mais tombant sur l\u2019onde T du complexe pr\u00e9c\u00e9dent du fait de son allongement marqu\u00e9. L\u2019apparition d\u2019un big\u00e9minisme ventriculaire chez un patient avec intervalle QT prolong\u00e9 doit faire redouter la survenue d\u2019une torsade de pointes, l\u2019allongement de la diastole li\u00e9e \u00e0 la pause post-extrasystolique prolongeant la repolarisation du complexe conduit. De m\u00eame, l\u2019alternance de l\u2019onde T ou de l\u2019onde U est un signe \u00e9lectrocardiographique pr\u00e9curseur de torsade. Ces extrasystoles sont g\u00e9n\u00e9ralement en rapport avec la survenue de post-d\u00e9polarisations pr\u00e9coces.\r\n\r\n3) un aspect de tachycardie tr\u00e8s \u00e9vocateur: la tachycardie est rapide et polymorphe, marqu\u00e9e par la succession rapide (en g\u00e9n\u00e9ral entre 50 et 250 bpm) de complexes ectopiques ventriculaires larges, de polarit\u00e9 variable avec rotation progressive et cyclique autour de la ligne iso\u00e9lectrique. La repolarisation reste g\u00e9n\u00e9ralement identifiable, la diff\u00e9renciation des complexes QRS et ondes T \u00e9tant le plus souvent possible ce qui diff\u00e8re d\u2019un trac\u00e9 de fibrillation ventriculaire (impossibilit\u00e9 d\u2019identifier complexes QRS et ondes T). Une torsion autour de la ligne de base est \u00e0 l\u2019origine du terme de torsades de pointes, le sens des \u201cpointes\u201d s\u2019inversant brutalement tous les 5 \u00e0 10 complexes (ou plus) parfois \u00e0 l\u2019occasion d\u2019un bref ralentissement de fr\u00e9quence. L\u2019aspect caract\u00e9ristique d\u2019ondulation du trac\u00e9 peut n\u2019apparaitre que dans certaines d\u00e9rivations, l\u2019enregistrement simultan\u00e9 de plusieurs d\u00e9rivations (notamment les d\u00e9rivations frontales) \u00e9tant n\u00e9cessaire pour mettre en \u00e9vidence l\u2019aspect h\u00e9lico\u00efdal du trac\u00e9. Les ondes P sont dissoci\u00e9es mais ne sont pas visibles.\r\n\r\nSi l\u2019arythmie est g\u00e9n\u00e9r\u00e9e par la survenue d\u2019une extrasystole en p\u00e9riode vuln\u00e9rable, sa p\u00e9rennisation est li\u00e9e \u00e0 des circuits de r\u00e9entr\u00e9e favoris\u00e9s par l\u2019inhomog\u00e9n\u00e9it\u00e9 des p\u00e9riodes r\u00e9fractaires (aspect de QT long), relativement lents et peu nombreux en raison des p\u00e9riodes r\u00e9fractaires longues. L\u2019activation \u00e9lectrique est moins anarchique que dans un \u00e9pisode de fibrillation ventriculaire et progresse de mani\u00e8re plus coh\u00e9rente, expliquant la nette diff\u00e9renciation des complexes QRS. Il n\u2019existe pas d\u2019explication compl\u00e8tement convaincante de la direction alternante des complexes QRS (existence de 2 ondulations diff\u00e9rentes, une ventriculaire gauche, l\u2019autre ventriculaire droite, s\u2019exprimant alternativement). \r\n\r\nCliniquement ce trouble du rythme entraine, si il se prolonge, une inefficacit\u00e9 cardiocirculatoire g\u00e9n\u00e9ratrice de perte de connaissance.\r\n\r\n4) des \u00e9pisodes spontan\u00e9ment r\u00e9solutifs: les torsades de pointes surviennent g\u00e9n\u00e9ralement par acc\u00e8s de quelques secondes \u00e0 quelques dizaines de seconde se r\u00e9duisant spontan\u00e9ment. La cessation spontan\u00e9e et souvent brutale de l\u2019acc\u00e8s apr\u00e8s une courte pause ventriculaire est caract\u00e9ristique de cette forme d\u2019arythmie, ce qui explique la survenue fr\u00e9quente d\u2019une syncope (retour spontan\u00e9 \u00e0 la conscience) plut\u00f4t qu\u2019une mort subite. Il existe une tendance marqu\u00e9e \u00e0 la r\u00e9cidive et certains acc\u00e8s prolong\u00e9s peuvent finir par d\u00e9g\u00e9n\u00e9rer en fibrillation ventriculaire.\r\n\r\nL\u2019arr\u00eat spontan\u00e9 des acc\u00e8s tient probablement dans l\u2019existence de p\u00e9riodes r\u00e9fractaires longues, d\u2019un nombre limit\u00e9 de circuits de r\u00e9entr\u00e9e, les p\u00e9riodes r\u00e9fractaires longues opposant une barri\u00e8re \u00e9lectrique \u00e0 la propagation et l\u2019entretien des circuits de r\u00e9entr\u00e9e.","ecg_info_post_answer":"<img class=\"alignnone wp-image-10390 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-513-1024x631.png\" alt=\"\" width=\"800\" height=\"493\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 8.13: Torsades de pointes - 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-8-13-torsades-de-pointes\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 8.13: Torsades de pointes - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-8-13-torsades-de-pointes\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-04T14:20:50+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-8-13-torsades-de-pointes\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-13-torsades-de-pointes\/\",\"name\":\"Trac\u00e9 8.13: Torsades de pointes - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-13-torsades-de-pointes\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-13-torsades-de-pointes\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-13-ecg-2.png\",\"datePublished\":\"2026-04-04T14:20:49+00:00\",\"dateModified\":\"2026-04-04T14:20:50+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-13-torsades-de-pointes\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-8-13-torsades-de-pointes\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-13-torsades-de-pointes\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-13-ecg-2.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-13-ecg-2.png\",\"width\":865,\"height\":763},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-13-torsades-de-pointes\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 8.13: Torsades de pointes\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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