{"id":10804,"date":"2026-06-28T03:04:05","date_gmt":"2026-06-28T03:04:05","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10804"},"modified":"2026-07-02T11:47:53","modified_gmt":"2026-07-02T11:47:53","slug":"trace-2-3-sinus-dysfunction-junctional-escape-exertional-dyspnea","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-3-sinus-dysfunction-junctional-escape-exertional-dyspnea\/","title":{"rendered":"Trace 2.3: Sinus dysfunction, junctional escape, exertional dyspnea"},"content":{"rendered":"","protected":false},"featured_media":9529,"template":"","ecg_case_type":[251],"language_ecgcase":[258],"class_list":["post-10804","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-sinus-dysfunction","language_ecgcase-english"],"acf":{"ecg_case_title":"Trace 2.3: Sinus dysfunction, junctional escape, exertional dyspnea","patient_description":"64-year-old man, dilated heart disease, hospitalized for asthenia and exercise intolerance;","quiz_question":"Regarding this ECG, which answer(s) is(are) true?","quiz_answer_1":"AF","quiz_answer_2":"sinus node dysfunction","quiz_answer_3":"atrial activity is retrograde","quiz_answer_4":"junctional escape","quiz_answer_5":"third-degree AV block","correct_answer":["B","C","D"],"ecg_image":9529,"ecg_description":"Bradycardia with heart rate of 45 beats\/minute, sinus node dysfunction with total absence of sinus P wave, likely junctional escape rhythm (regular and moderately slow QRS), with right bundle branch block pattern; retrograde conduction (negative atrial activity in inferior leads with fixed RP\u2019 interval);","ecg_info_box":"Chronotropic incompetence corresponds to a particular form of sinus node dysfunction with appearance or increase of symptoms in relation to an insufficient acceleration of the heart rate. The implantation of a controlled pacemaker (possibility of accelerating the pacing rate in response to exercise constitutes the reference treatment.","commentary_ecg":"This patient was symptomatic with presence of asthenia and exertional dyspnea. The exercise test revealed a marked chronotropic incompetence with dyspnea appearing at the first stages in conjunction with a near total absence of heart rate acceleration and the persistence of a junctional escape rhythm without reappearance of normal sinus activity. The presence of this chronotropic incompetence without curable cause led to the decision to implant a pacemaker (class I indication). There is indeed consensus regarding the fact that implantation of a pacemaker does not improve the survival of patients with sinus node dysfunction but does allow to reduce associated symptoms. There is therefore no theoretical indication in asymptomatic patients (class III).","ecg_info_post_answer":"<img class=\"alignnone wp-image-10808 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/06\/trace-2-3-ecg-en-1024x576.jpg\" alt=\"\" width=\"800\" height=\"450\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trace 2.3: Sinus dysfunction, junctional escape, exertional dyspnea - 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-2-3-sinus-dysfunction-junctional-escape-exertional-dyspnea\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trace 2.3: Sinus dysfunction, junctional escape, exertional dyspnea - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-2-3-sinus-dysfunction-junctional-escape-exertional-dyspnea\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-07-02T11:47:53+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-2-3-ecg-scaled.png\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1511\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-3-sinus-dysfunction-junctional-escape-exertional-dyspnea\\\/\",\"url\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-3-sinus-dysfunction-junctional-escape-exertional-dyspnea\\\/\",\"name\":\"Trace 2.3: Sinus dysfunction, junctional escape, exertional dyspnea - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-3-sinus-dysfunction-junctional-escape-exertional-dyspnea\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-3-sinus-dysfunction-junctional-escape-exertional-dyspnea\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/cardiocases.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/trace-2-3-ecg-scaled.png\",\"datePublished\":\"2026-06-28T03:04:05+00:00\",\"dateModified\":\"2026-07-02T11:47:53+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-3-sinus-dysfunction-junctional-escape-exertional-dyspnea\\\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-3-sinus-dysfunction-junctional-escape-exertional-dyspnea\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-3-sinus-dysfunction-junctional-escape-exertional-dyspnea\\\/#primaryimage\",\"url\":\"https:\\\/\\\/cardiocases.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/trace-2-3-ecg-scaled.png\",\"contentUrl\":\"https:\\\/\\\/cardiocases.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/trace-2-3-ecg-scaled.png\",\"width\":2560,\"height\":1511},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-2-3-sinus-dysfunction-junctional-escape-exertional-dyspnea\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/cardiocases.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trace 2.3: Sinus dysfunction, junctional escape, exertional dyspnea\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/#website\",\"url\":\"https:\\\/\\\/cardiocases.com\\\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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