{"id":3278,"date":"2025-10-07T13:32:34","date_gmt":"2025-10-07T13:32:34","guid":{"rendered":"https:\/\/cardiocases.com\/?page_id=3278"},"modified":"2025-11-09T14:22:41","modified_gmt":"2025-11-09T14:22:41","slug":"p-wave-oversensing","status":"publish","type":"page","link":"https:\/\/cardiocases.com\/fr\/pacing-defibrillation\/basic-concepts\/icd\/p-wave-oversensing\/","title":{"rendered":"Surd\u00e9tection de l'onde P"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"3278\" class=\"elementor elementor-3278\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-acb24a1 e-con-full e-flex e-con e-parent\" data-id=\"acb24a1\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-bd941c5 elementor-widget elementor-widget-heading\" data-id=\"bd941c5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Surd\u00e9tection de l'onde P<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2cd72e7 elementor-widget elementor-widget-text-editor\" data-id=\"2cd72e7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>La surd\u00e9tection de la d\u00e9polarisation atriale par la sonde ventriculaire droite est rare et s'observe principalement chez les patients implant\u00e9s avec une sonde bipolaire int\u00e9gr\u00e9e. Chez un patient en rythme sinusal, la sonde ventriculaire droite d\u00e9tecte \u00e0 la fois la d\u00e9polarisation atriale et la d\u00e9polarisation ventriculaire, l'espace PR \u00e9tant plus long que le blanking ventriculaire. Si le patient pr\u00e9sente un bloc auriculo-ventriculaire complet, la surd\u00e9tection de l'onde P peut inhiber la stimulation ventriculaire et g\u00e9n\u00e9rer une asystolie.<\/p><p>De m\u00eame, la surd\u00e9tection de la d\u00e9polarisation atriale lors d'un flutter ou d'une tachycardie atriale peut causer \u00e0 la fois la survenue de th\u00e9rapies inappropri\u00e9es et d'une asystolie si le patient est d\u00e9pendant.<\/p><p>La surd\u00e9tection du signal auriculaire survient pr\u00e9f\u00e9rentiellement dans 2 situations 1) d\u00e9placement de la sonde ventriculaire droite \u00e0 la jonction atrioventriculaire (co\u00efncide avec une baisse de l'amplitude de l'onde R mesur\u00e9e) 2) positionnement d'une sonde bipolaire int\u00e9gr\u00e9e pr\u00e8s de l'anneau tricuspide, le co\u00efl distal \u00e9tant situ\u00e9 \u00e0 cheval sur la valve (co\u00efncide avec une amplitude de l'onde R pr\u00e9serv\u00e9e). Cette observation est plus fr\u00e9quente chez les patients pr\u00e9sentant une petite cavit\u00e9 cardiaque: enfants, myocardiopathie hypertrophique.<\/p><p>Dans un d\u00e9fibrillateur triple chambre, si la sonde ventriculaire gauche recule dans le sinus coronaire, elle peut d\u00e9tecter l'activit\u00e9 auriculaire et provoquer une perte de stimulation ventriculaire gauche sur les appareils dot\u00e9s d'une d\u00e9tection de la sonde ventriculaire gauche.<\/p><p>La surd\u00e9tection de l'onde P se traduit par une alternance entre deux signaux de morphologie diff\u00e9rente, une alternance entre deux cycles avec un aspect caract\u00e9ristique de rail sur le graphique (identique \u00e0 celui observ\u00e9 lorsque l'onde R est compt\u00e9e deux fois). Le cycle PR est class\u00e9 en FV, et la classification de l'espace RP d\u00e9pend de la fr\u00e9quence cardiaque, des zones programm\u00e9es et du fabricant (fr\u00e9quemment non class\u00e9 dans un d\u00e9fibrillateur Abbott, ce qui explique le taux \u00e9lev\u00e9 de th\u00e9rapies inappropri\u00e9es avec ce type d'appareil).<\/p><p>Si la surd\u00e9tection de l'onde P se produit en rythme sinusal, une strat\u00e9gie possible consiste \u00e0 forcer la stimulation auriculaire en utilisant le mode DDDR et un algorithme de surmultiplication auriculaire pour augmenter la fr\u00e9quence cardiaque et emp\u00eacher la sensibilit\u00e9 d'atteindre sa valeur maximale. La suppression ventriculaire induite par la stimulation auriculaire peut \u00e9galement emp\u00eacher l'\u00e9coute crois\u00e9e. Toutefois, cette solution est g\u00e9n\u00e9ralement temporaire et ne prot\u00e8ge pas le patient d'une \u00e9ventuelle sur-sensibilit\u00e9 pendant une arythmie supraventriculaire.<\/p><p>Dans la plupart des cas, la surd\u00e9tection de l'onde P n\u00e9cessite un repositionnement de la sonde de d\u00e9fibrillation (nouvelle sonde de d\u00e9fibrillation si le syst\u00e8me DF4 est utilis\u00e9, ou ajout d'une sonde de stimulation\/d\u00e9tection si le syst\u00e8me DF1 est utilis\u00e9).<\/p><p>Pour minimiser le risque de surd\u00e9tection d\u2019ondes P, il est important lors de l\u2019implantation de s\u2019assurer que la bobine distale est compl\u00e8tement situ\u00e9e dans la cavit\u00e9 ventriculaire droite lorsqu\u2019une d\u00e9rivation bipolaire int\u00e9gr\u00e9e est implant\u00e9e.<\/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>P-wave oversensing Overdetection of atrial depolarization by the right ventricular lead is rare and is mainly observed in patients implanted with an integrated bipolar lead. In a patient in sinus rhythm, the right ventricular lead detects both atrial and ventricular depolarization, as the PR interval is longer than ventricular blanking. If the patient has complete [&hellip;]<\/p>\n","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-3278","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICD P-Wave Oversensing | ECG Tracings | Cardiocases<\/title>\n<meta name=\"description\" content=\"ICD far-field P-wave oversensing \u2014 causes, ECG recognition, reprogramming &amp; real device tracings. 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