{"id":133,"date":"2025-07-09T09:42:34","date_gmt":"2025-07-09T09:42:34","guid":{"rendered":"https:\/\/cardiocases.com\/?page_id=133"},"modified":"2025-10-07T13:27:37","modified_gmt":"2025-10-07T13:27:37","slug":"lead-dysfunction","status":"publish","type":"page","link":"https:\/\/cardiocases.com\/fr\/pacing-defibrillation\/basic-concepts\/icd\/lead-dysfunction\/","title":{"rendered":"Dysfonction de sonde"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"133\" class=\"elementor elementor-133\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4a5624c e-con-full e-flex e-con e-parent\" data-id=\"4a5624c\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-87dc57c elementor-widget elementor-widget-heading\" data-id=\"87dc57c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Dysfonction de sonde<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1821716 e-con-full e-flex e-con e-parent\" data-id=\"1821716\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f74e138 elementor-widget elementor-widget-text-editor\" data-id=\"f74e138\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>La sonde constitue le maillon faible du syst\u00e8me de d\u00e9fibrillation avec un pourcentage de dysfonction variable en fonction des mod\u00e8les. Une rupture de sonde peut entrainer la survenue de th\u00e9rapies inappropri\u00e9es multiples pouvant grever la qualit\u00e9 de vie des patients implant\u00e9s. Devant une suspiscion de rupture de sonde, diff\u00e9rents examens et mesures doivent \u00eatre r\u00e9alis\u00e9s:<\/p><ol><li>radiographie du poumon: les anomalies radiographiques ne sont pas syst\u00e9matiques et un aspect typique de fracture de sonde n'est pas observ\u00e9 dans plus de 50% des cas.\u00a0\u00a0<\/li><li>mesures r\u00e9p\u00e9t\u00e9es des imp\u00e9dances de stimulation et de d\u00e9fibrillation: les derni\u00e8res g\u00e9n\u00e9rations de d\u00e9fibrillateur r\u00e9alisent des mesures p\u00e9riodiques (quotidiennes) des imp\u00e9dances avec une bonne corr\u00e9lation entre mesure infra-liminaire et mesure r\u00e9elle sur un choc haute amplitude effectivement d\u00e9livr\u00e9. L'existence d'une valeur anormale ou de variations importantes dans les mesures quotidiennes (rupture de la courbe d'imp\u00e9dance) peut r\u00e9v\u00e9ler une dysfonction de sonde avec toutefois une sensibilit\u00e9 mod\u00e9r\u00e9e. En effet, un nombre important de patients pr\u00e9sente une dysfonction de sonde r\u00e9v\u00e9l\u00e9e par l'existence d'\u00e9pisodes de surd\u00e9tection sans mesure anormale d'imp\u00e9dance ou sans variation abrupte des valeurs. Une valeur basse d'imp\u00e9dance est en faveur d'une rupture d'isolant (fuite de courant), une valeur haute en faveur d'une rupture du conducteur (perte de continuit\u00e9 du circuit de d\u00e9fibrillation). \u00a0\u00a0<\/li><li>\u00e9valuation des seuils de d\u00e9tection et de stimulation: l'alt\u00e9ration des param\u00e8tres standards de stimulation est souvent tardive; la sensibilit\u00e9 d'une baisse de la d\u00e9tection ventriculaire ou une augmentation des seuils de stimulation pour pr\u00e9dire une rupture de sonde est donc tr\u00e8s faible.\u00a0<\/li><li>l'analyse des diff\u00e9rents \u00e9lectrogrammes endocavitaires: l'aspect des EGMs endocavitaires associ\u00e9s \u00e0 une rupture de sonde est suggestif mais peu sp\u00e9cifique: d\u00e9tection intermittente de cycles cardiaques anarchiques, rapides, non physiologiques avec possible saturation des amplificateurs (rupture du conducteur) ou faible amplitude (d\u00e9tection de myopotentiels sur rupture d'isolant). Ces signaux pr\u00e9sentent une variabilit\u00e9 importante en amplitude et en fr\u00e9quence, sont intermittents dans le cycle cardiaque et sont le plus souvent enregistr\u00e9s en zone de FV avec des valeurs proches du blanking ventriculaire post-d\u00e9tection. Ils peuvent affecter le canal de d\u00e9tection et\/ou le canal de choc en fonction du site de fracture et peuvent ne devenir apparents qu'apr\u00e8s un choc \u00e9lectrique d\u00e9livr\u00e9 sur un v\u00e9ritable \u00e9pisode de FV.<\/li><\/ol><p>\u00a0<\/p><p>l'analyse des diff\u00e9rents \u00e9lectrogrammes endocavitaires: l'aspect des EGMs endocavitaires associ\u00e9s \u00e0 une rupture de sonde est suggestif mais peu sp\u00e9cifique: d\u00e9tection intermittente de cycles cardiaques anarchiques, rapides, non physiologiques avec possible saturation des amplificateurs (rupture du conducteur) ou faible amplitude (d\u00e9tection de myopotentiels sur rupture d'isolant). Ces signaux pr\u00e9sentent une variabilit\u00e9 importante en amplitude et en fr\u00e9quence, sont intermittents dans le cycle cardiaque et sont le plus souvent enregistr\u00e9s en zone de FV avec des valeurs proches du blanking ventriculaire post-d\u00e9tection. Ils peuvent affecter le canal de d\u00e9tection et\/ou le canal de choc en fonction du site de fracture et peuvent ne devenir apparents qu'apr\u00e8s un choc \u00e9lectrique d\u00e9livr\u00e9 sur un v\u00e9ritable \u00e9pisode de FV.<\/p><p>D'autres pr\u00e9sentations atypiques sont proches de celle d'une dysfonction de sonde avec l'association d'une anomalie d'imp\u00e9dance et d'une surd\u00e9tection: interaction entre 2 sondes (contact entre la sonde de d\u00e9fibrillation et un fragment de sonde restant ou une sonde ventriculaire droite abandonn\u00e9e), pr\u00e9sence d'air dans le connecteur avec un aspect sp\u00e9cifique de surd\u00e9tection correspondant aux bulles d'air s'\u00e9chappant du connecteur.<\/p><p>La diff\u00e9rentiation entre ces diff\u00e9rentes situations cliniques est essentielle mais parfois difficile, pour \u00e9viter un faux diagnostic de rupture de sonde qui a des implications th\u00e9rapeutiques importantes (n\u00e9cessit\u00e9 de remplacer la sonde et discussion sur la n\u00e9cessit\u00e9 d'extraction de la sonde \"d\u00e9fectueuse\").<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Lead dysfunction One of the most common causes of oversensing and resultant inappropriate shocks is lead fracture. A systematic approach to the patient with suspected lead failure includes: a chest X-ray: radiographic abnormalities are not systematic and a conductor fracture can only be identified in less than half of the patients with ICD lead malfunctions.\u00a0\u00a0 [&hellip;]<\/p>","protected":false},"author":1,"featured_media":0,"parent":19,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-133","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICD Lead Dysfunction | ECG Diagnosis | Cardiocases<\/title>\n<meta name=\"description\" content=\"ICD lead dysfunction \u2014 fracture, insulation failure, dislodgement &amp; ECG recognition. For electrophysiologists.\" \/>\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\/pacing-defibrillation\/basic-concepts\/icd\/lead-dysfunction\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICD Lead Dysfunction | ECG Diagnosis | Cardiocases\" \/>\n<meta property=\"og:description\" content=\"ICD lead dysfunction \u2014 fracture, insulation failure, dislodgement &amp; ECG recognition. 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