{"id":161,"date":"2025-07-09T09:54:35","date_gmt":"2025-07-09T09:54:35","guid":{"rendered":"https:\/\/cardiocases.com\/?page_id=161"},"modified":"2025-10-07T13:30:54","modified_gmt":"2025-10-07T13:30:54","slug":"diafragmatic-myopotentials","status":"publish","type":"page","link":"https:\/\/cardiocases.com\/fr\/pacing-defibrillation\/basic-concepts\/icd\/diafragmatic-myopotentials\/","title":{"rendered":"Myopotentiels diaphragmatiques"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"161\" class=\"elementor elementor-161\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b8568dc e-con-full e-flex e-con e-parent\" data-id=\"b8568dc\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-324b748 elementor-widget elementor-widget-heading\" data-id=\"324b748\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Myopotentiels diaphragmatiques<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-55f037e e-con-full e-flex e-con e-parent\" data-id=\"55f037e\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6358234 elementor-widget elementor-widget-text-editor\" data-id=\"6358234\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>L'utilisation d'une sensibilit\u00e9 \u00e9lev\u00e9e auto-adaptative permet d'optimiser la qualit\u00e9 de la d\u00e9tection des signaux micro-volt\u00e9s en FV mais majore le risque de surd\u00e9tection de myopotentiels diaphragmatiques en fin de diastole quand la sensibilit\u00e9 est maximale.<\/p><p>La stimulation continue est une variable associ\u00e9e \u00e0 un risque accru de surdosage diaphragmatique car, apr\u00e8s la stimulation, le temps de sensibilit\u00e9 maximale est prolong\u00e9 dans les dispositifs qui utilisent le contr\u00f4le automatique du gain, en particulier \u00e0 des fr\u00e9quences cardiaques lentes.  Chez les patients d\u00e9pendants de la stimulation, le risque d'inhibition de la MP pendant les \u00e9pisodes de surd\u00e9tection est \u00e9galement accru. Cliniquement, cela peut entra\u00eener une syncope due \u00e0 l'inhibition de la stimulation suivie de l'administration d'un choc inappropri\u00e9.<\/p><p>La surd\u00e9tection de myopotentiels diaphragmatiques est rare mais a \u00e9t\u00e9 observ\u00e9e de fa\u00e7on accrue chez les patients implant\u00e9s avec un dispositif Boston Scientific ancien connect\u00e9 avec une sonde bipolaire int\u00e9gr\u00e9e positionn\u00e9e \u00e0 l'apex ventriculaire droite. Une stimulation ventriculaire permanente est associ\u00e9e avec un risque augment\u00e9 de surd\u00e9tection de ces myopotentiels car apr\u00e8s stimulation, le temps pass\u00e9 avec une sensibilit\u00e9 maximale est prolong\u00e9 particuli\u00e8rement quand la fr\u00e9quence cardiaque est lente. Une sonde bipolaire int\u00e9gr\u00e9e favorise le ph\u00e9nom\u00e8ne parce que l'antenne de d\u00e9tection est plus large. Chez les patients d\u00e9pendants (bloc auriculo-ventriculaire complet), une surd\u00e9tection peut g\u00e9n\u00e9rer une inhibition et une pause prolong\u00e9e (risque de syncope sur bradycardie plus ou moins suivie par un choc \u00e9lectrique).\u00a0\u00a0\u00a0<\/p><p>Les myopotentiels diaphragmatiques correspondent \u00e0 des signaux de faible amplitude, haute fr\u00e9quence, d\u00e9tect\u00e9s le plus souvent exclusivement sur le canal de d\u00e9tection (absents sur le canal de choc). Les 2 caract\u00e9ristiques principales de ce type de signaux sont que leur amplitude varie avec le cycle respiratoire et qu'ils peuvent \u00eatre reproduits par des man\u0153uvres sp\u00e9cifiques (inspiration profonde, Vasalva, toux forc\u00e9e).<\/p><p>La sur\u00e9dtection survient initialement en fin de diastole (particuli\u00e8rement quand la fr\u00e9quence cardiaque est basse) quand la sensibilit\u00e9 est maximale. La d\u00e9tection de la v\u00e9ritable onde R (de grande amplitude) modifie le niveau de sensibilit\u00e9 et interrompt au moins temporairement la surd\u00e9tection de ces signaux de petite taille ce qui explique qu'une surd\u00e9tection prolong\u00e9e ne survienne que chez les patients d\u00e9pendants (absence d'onde R spontan\u00e9e).<\/p><p>Pour \u00e9viter ce type de surd\u00e9tection, il est possible de r\u00e9duire le niveau de sensibilit\u00e9 avec n\u00e9cessit\u00e9 de v\u00e9rifier la d\u00e9tection correcte des signaux en FV. Chez les patients stimul\u00e9s, une augmentation de la fr\u00e9quence minimale de stimulation peut \u00e9galement avoir un effet favorable. Il est parfois n\u00e9cessaire d'implanter une nouvelle sonde de d\u00e9fibrillation (syst\u00e8me DF4) ou de stimulation (syst\u00e8me DF1) \u00e0 distance du diaphragme (septum ou infundibulum).\n\nL'incidence de ce type de probl\u00e8me (inhibition ou th\u00e9rapies inappropri\u00e9es) a diminu\u00e9 sur les derni\u00e8res plateformes de d\u00e9fibrillateur Boston Scientific avec l'introduction de l'algorithme de r\u00e9jection du bruit.<\/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>Diafragmatic myopotentials The use of automatic gain control and auto-adjusting sensitivity algorithms throughout the cardiac cycle, optimizes the capacities of the device to appropriately sense VF signals but also increases the risk of myopotential oversensing at the end of diastole, when sensitivity reaches its maximum. Myopotential oversensing is rare but was more commonly observed in [&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-161","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 Diaphragmatic Myopotential Oversensing | Cardiocases<\/title>\n<meta name=\"description\" content=\"Diafragmatic myopotentials\" \/>\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\/diafragmatic-myopotentials\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICD Diaphragmatic Myopotential Oversensing | Cardiocases\" \/>\n<meta property=\"og:description\" content=\"Diafragmatic myopotentials\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/pacing-defibrillation\/basic-concepts\/icd\/diafragmatic-myopotentials\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-07T13:30:54+00:00\" \/>\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=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cardiocases.com\/pacing-defibrillation\/basic-concepts\/icd\/diafragmatic-myopotentials\/\",\"url\":\"https:\/\/cardiocases.com\/pacing-defibrillation\/basic-concepts\/icd\/diafragmatic-myopotentials\/\",\"name\":\"ICD Diaphragmatic Myopotential Oversensing | Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"datePublished\":\"2025-07-09T09:54:35+00:00\",\"dateModified\":\"2025-10-07T13:30:54+00:00\",\"description\":\"Diafragmatic myopotentials\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/pacing-defibrillation\/basic-concepts\/icd\/diafragmatic-myopotentials\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/pacing-defibrillation\/basic-concepts\/icd\/diafragmatic-myopotentials\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/pacing-defibrillation\/basic-concepts\/icd\/diafragmatic-myopotentials\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Pacing &amp; 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