{"id":3194,"date":"2025-10-07T12:33:43","date_gmt":"2025-10-07T12:33:43","guid":{"rendered":"https:\/\/cardiocases.com\/?page_id=3194"},"modified":"2025-10-07T12:45:03","modified_gmt":"2025-10-07T12:45:03","slug":"double-counting-the-r-wave","status":"publish","type":"page","link":"https:\/\/cardiocases.com\/fr\/pacing-defibrillation\/basic-concepts\/icd\/double-counting-the-r-wave\/","title":{"rendered":"Double comptage de l'onde R"},"content":{"rendered":"
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Double comptage de l'onde R<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Le double comptage de l'onde R est exceptionnel sur les d\u00e9fibrillateurs de derni\u00e8re g\u00e9n\u00e9ration. Chez quelques rares patients avec trouble majeur de la conduction intra-ventriculaire et QRS large, l'EGM ventriculaire peut exc\u00e9der la dur\u00e9e du blanking ventriculaire (p\u00e9riode r\u00e9fractaire post-d\u00e9tection ventriculaire) et un m\u00eame signal peut \u00eatre d\u00e9tect\u00e9 2 fois. Certaines drogues (bloqueurs des canaux sodiques particuli\u00e8rement pour des fr\u00e9quences cardiaques \u00e9lev\u00e9es) ou certains troubles m\u00e9taboliques (hyperkali\u00e9mie) peuvent favoriser cette surd\u00e9tection en allongeant la dur\u00e9e du QRS. Le double comptage de l'onde R peut \u00e9galement survenir chez un patient avec un d\u00e9fibrillateur double chambre, espace PR allong\u00e9 et perte de capture ventriculaire droite. Le d\u00e9fibrillateur compte \u00e0 la fois l'\u00e9v\u00e8nement ventriculaire stimul\u00e9 et le ventricule spontan\u00e9 conduit depuis l'oreillette. De m\u00eame chez un patient avec d\u00e9fibrillateur triple chambre et perte de capture ventriculaire droite, le dispositif peut compter \u00e0 la fois l'\u00e9v\u00e8nement ventriculaire stimul\u00e9 et la d\u00e9polarisation ventriculaire droite provenant de la capture ventriculaire gauche.<\/p>

L'aspect de l'EGM lors d'un double comptage de l'onde R est relativement caract\u00e9ristique avec une alternance entre 2 dur\u00e9es de cycle ventriculaire. Cette alternance est associ\u00e9e avec un aspect en rail sur le graphe (2 lignes distinctes correspondant aux 2 cycles R1R2 et R2R1). Le second signal (R2) est g\u00e9n\u00e9ralement d\u00e9tect\u00e9 en fin de la p\u00e9riode de blanking (l'intervalle R1R2 est exactement \u00e9gal au blanking programm\u00e9 ou dans une limite de + 20 ms) et correspond toujours \u00e0 la zone de FV. La classification du second cycle (R2R1) d\u00e9pend de la programmation des zones de tachycardie et de la fr\u00e9quence cardiaque (probabilit\u00e9 plus \u00e9lev\u00e9e d'\u00eatre en zone de tachycardie si la fr\u00e9quence est \u00e9lev\u00e9e et si les zones de tachycardie sont programm\u00e9es basses). Le double comptage peut survenir sur un rythme sinusal, sur une extrasystole ventriculaire ou uniquement sur une TV lente (souvent QRS large; risque d'une classification erron\u00e9e en zone de FV et th\u00e9rapies inutilement agressives).<\/p>

L'allongement du blanking ventriculaire, quand ce param\u00e8tre est programmable, permet g\u00e9n\u00e9ralement de supprimer ce probl\u00e8me de surd\u00e9tection et doit \u00eatre propos\u00e9 en premi\u00e8re intention tout en gardant \u00e0 l'esprit qu'un allongement excessif peut conduire \u00e0 un risque accru de sous-d\u00e9tection d'une v\u00e9ritable FV.\u00a0<\/p>

Une diminution de la sensibilit\u00e9 ventriculaire peut parfois permettre de r\u00e9gler le probl\u00e8me mais cette option peut \u00e9galement g\u00e9n\u00e9rer un risque de sous-d\u00e9tection de FV. De plus, cette option est souvent inefficace car le second signal ventriculaire peut \u00eatre d'amplitude au moins \u00e9gal au premier. R\u00e9gler une zone de FV tr\u00e8s \u00e9lev\u00e9e pour \u00e9viter les th\u00e9rapies inappropri\u00e9es dans ce cadre ne parait pas non plus adapt\u00e9. Dans les rares cas o\u00f9 la p\u00e9riode de blanking ne peut pas \u00eatre allong\u00e9 suffisamment, l'implantation d'une nouvelle sonde de stimulation\/d\u00e9fibrillation peut \u00eatre propos\u00e9e.<\/p>

Chez les patients pr\u00e9sentant un QRS tr\u00e8s \u00e9largi, il est indispensable durant l'implantation d'analyser attentivement l'aspect et la largeur de la d\u00e9polarisation ventriculaire intra-cavitaire et de v\u00e9rifier l'absence de tout double comptage ventriculaire. Il est probablement \u00e9galement plus ad\u00e9quat d'implanter dans ce cadre un d\u00e9fibrillateur avec un blanking ventriculaire programmable connect\u00e9 avec une sonde bipolaire d\u00e9di\u00e9e (plut\u00f4t qu'une sonde bipolaire int\u00e9gr\u00e9e qui favorise le double comptage).<\/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":"

Double counting the R-wave Double counting of the R wave is rare in the latest generation of defibrillators. In a few rare patients with major intraventricular conduction disorders and wide QRS complexes, the ventricular EGM may exceed the ventricular blanking period (post-detection refractory period) and the same signal may be detected twice. Certain drugs (sodium […]<\/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-3194","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\nICD R-Wave Double Counting | ECG | Cardiocases<\/title>\n<meta name=\"description\" content=\"ICD R-wave double counting \u2014 causes, ECG recognition, sensing adjustment & real device tracings. 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