{"id":10279,"date":"2026-04-04T14:21:59","date_gmt":"2026-04-04T14:21:59","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10279"},"modified":"2026-04-04T14:21:59","modified_gmt":"2026-04-04T14:21:59","slug":"trace-8-14-torsades-de-pointes-apres-reduction-dun-episode-de-fibrillation-auriculaire","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-8-14-torsades-de-pointes-apres-reduction-dun-episode-de-fibrillation-auriculaire\/","title":{"rendered":"Trac\u00e9 8.14: Torsades de pointes apr\u00e8s r\u00e9duction d\u2019un \u00e9pisode de fibrillation auriculaire"},"content":{"rendered":"","protected":false},"featured_media":10278,"template":"","ecg_case_type":[257],"language_ecgcase":[259],"class_list":["post-10279","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 8.14: Torsades de pointes apr\u00e8s r\u00e9duction d\u2019un \u00e9pisode de fibrillation auriculaire","patient_description":"Patiente de 84 ans aux ant\u00e9c\u00e9dents de fibrillation auriculaire paroxystique, hospitalis\u00e9e pour palpitations et signes d\u2019insuffisance cardiaque gauche; introduction d\u2019une dose de charge d\u2019amiodarone et d\u2019un traitement par diur\u00e9tiques intraveineux; \u00e9pisodes de lipothy\u00ad mie","quiz_question":"Sur cet ECG, on retrouve:","quiz_answer_1":"au d\u00e9but du trac\u00e9, une arythmie supraventriculaire","quiz_answer_2":"une pause sur bloc auriculo-ventriculaire","quiz_answer_3":"une pause post-r\u00e9ductionnelle","quiz_answer_4":"une torsade de pointes","quiz_answer_5":"une fibrillation atriale sur voie accessoire (syndrome de Wolff Parkinson White)","correct_answer":["A","C","D"],"ecg_image":10278,"ecg_description":"On retrouve au d\u00e9but du trac\u00e9 une tachycardie \u00e0 QRS fin correspondant \u00e0 une probable fibrillation auriculaire; r\u00e9duction de l\u2019arythmie et pause sinusale post-r\u00e9ductionnelle; signes d\u2019hypertrophie auriculaire gauche; sur le premier complexe QRS suivant la pause, allongement sensible de l\u2019intervalle QT; extrasystole ventriculaire peu pr\u00e9coce tombant sur l\u2019onde T (partie descendante de l\u2019onde T); induction d\u2019une arythmie sur 8 complexes, tachycardie \u00e0 QRS large, irr\u00e9guli\u00e8re, polymorphe avec aspect caract\u00e9ristique de torsade de pointes: amplitude variable des complexes QRS avec rotation autour de la ligne de base plus ou moins visible en fonction des d\u00e9rivations; r\u00e9duction spontan\u00e9e; nouvelle pause sinusale, QT long et extrasystole ventriculaire","ecg_info_box":"L\u2019association amiodarone et diur\u00e9tiques chez une patiente \u00e2g\u00e9e pr\u00e9sentant une d\u00e9compensation cardiaque sur passage en fibrillation auriculaire peut favoriser la survenue d\u2019une torsade de pointes \u00e0 la r\u00e9duction.","commentary_ecg":"Ce trac\u00e9 correspond \u00e0 une situation clinique assez fr\u00e9quemment observ\u00e9e: syncope chez une patiente \u00e2g\u00e9e, hospitalis\u00e9e pour d\u00e9compensation cardiaque sur passage en fibrillation auriculaire. Un traitement par amiodarone et diur\u00e9tique est alors souvent propos\u00e9; ce traitement permet la r\u00e9duction de l\u2019arythmie et la suppression des sympt\u00f4mes d\u2019insuffisance cardiaque. La syncope survient au moment de la r\u00e9duction de l\u2019arythmie, plus souvent sur une torsade de pointe que sur la pause post-r\u00e9ductionnelle. En effet, l\u2019association entre la pause sinusale, le traitement par amiodarone et diur\u00e9tiques (hypokali\u00e9mie relative) a un effet synergique favorisant la survenue d\u2019une bradycardie associ\u00e9e avec un allongement marqu\u00e9 de l\u2019intervalle QT, les 2 pr\u00e9requis n\u00e9cessaires \u00e0 la survenue d\u2019une torsades de pointes.\r\n\r\nLes syndromes du QT long cong\u00e9nitaux ou iatrog\u00e8nes sont caus\u00e9s par des anomalies intrins\u00e8ques ou acquises des courants ioniques impliqu\u00e9s dans la repolarisation ventriculaire. Ces anomalies peuvent \u00eatre major\u00e9s par la prise d\u2019un traitement allongeant l\u2019intervalle QT dans des conditions de trouble m\u00e9tabolique (hypokali\u00e9mie, hypomagn\u00e9s\u00e9mie). Il est possible que certains patients avec un allongement anormal de l\u2019intervalle QT \u00e0 la suite d\u2019une prise m\u00e9dicamenteuse, pr\u00e9sentent une pr\u00e9disposition g\u00e9n\u00e9tique au pr\u00e9alable silencieuse, s\u2019exprimant dans des conditions particuli\u00e8res. M\u00eame si il est difficile de pr\u00e9dire quels patients sont \u00e0 risque de torsade de pointes, l\u2019introduction d\u2019un traitement combin\u00e9 antiarythmique (classe I ou classe III) et diur\u00e9tique de l\u2019anse chez un patient \u00e2g\u00e9 pour fibrillation auriculaire n\u00e9cessite une surveillance rapproch\u00e9e, l\u2019allongement de l\u2019espace QT et la bradycardie qui initient l\u2019arythmie pouvant survenir au moment de la r\u00e9duction. L\u2019intervalle QT de cette patiente \u00e9tait par exemple parfaitement normal au d\u00e9but du trac\u00e9.","ecg_info_post_answer":"<img class=\"alignnone wp-image-10391 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-517-1024x685.png\" alt=\"\" width=\"800\" height=\"535\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 8.14: Torsades de pointes apr\u00e8s r\u00e9duction d\u2019un \u00e9pisode de fibrillation auriculaire - 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-8-14-torsades-de-pointes-apres-reduction-dun-episode-de-fibrillation-auriculaire\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 8.14: Torsades de pointes apr\u00e8s r\u00e9duction d\u2019un \u00e9pisode de fibrillation auriculaire - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-8-14-torsades-de-pointes-apres-reduction-dun-episode-de-fibrillation-auriculaire\/\" \/>\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-8-14-torsades-de-pointes-apres-reduction-dun-episode-de-fibrillation-auriculaire\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-14-torsades-de-pointes-apres-reduction-dun-episode-de-fibrillation-auriculaire\/\",\"name\":\"Trac\u00e9 8.14: Torsades de pointes apr\u00e8s r\u00e9duction d\u2019un \u00e9pisode de fibrillation auriculaire - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-14-torsades-de-pointes-apres-reduction-dun-episode-de-fibrillation-auriculaire\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-14-torsades-de-pointes-apres-reduction-dun-episode-de-fibrillation-auriculaire\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-14-ecg-2.png\",\"datePublished\":\"2026-04-04T14:21:59+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-14-torsades-de-pointes-apres-reduction-dun-episode-de-fibrillation-auriculaire\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-8-14-torsades-de-pointes-apres-reduction-dun-episode-de-fibrillation-auriculaire\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-14-torsades-de-pointes-apres-reduction-dun-episode-de-fibrillation-auriculaire\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-14-ecg-2.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-8-14-ecg-2.png\",\"width\":1093,\"height\":742},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-8-14-torsades-de-pointes-apres-reduction-dun-episode-de-fibrillation-auriculaire\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 8.14: Torsades de pointes apr\u00e8s r\u00e9duction d\u2019un \u00e9pisode de fibrillation auriculaire\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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