{"id":287,"date":"2019-08-06T14:58:35","date_gmt":"2019-08-06T12:58:35","guid":{"rendered":"https:\/\/admsu.org\/w\/?p=287"},"modified":"2019-08-06T14:58:35","modified_gmt":"2019-08-06T12:58:35","slug":"ecg-n12-reponse","status":"publish","type":"post","link":"https:\/\/admsu.org\/w\/ecg-n12-reponse\/","title":{"rendered":"ECG n\u00b012 &#8211; R\u00e9ponse"},"content":{"rendered":"\n<figure class=\"wp-block-image\"><a href=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/Capture.png\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/Capture-1024x683.png\" alt=\"\" class=\"wp-image-288\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/Capture-1024x683.png 1024w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/Capture-300x200.png 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/Capture-768x512.png 768w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/Capture.png 1251w\" sizes=\"auto, (max-width: 767px) 89vw, (max-width: 1000px) 54vw, (max-width: 1071px) 543px, 580px\" \/><\/a><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Interpr\u00e9tation<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>Rythme sinusal et r\u00e9gulier, les ondes P sont parfois confondues \u00e0 l&#8217;onde T laissant apparaitre un aspect d&#8217;onde T bifide en V1-V2. En observant d&#8217;autres d\u00e9rivations on comprend la fusion des ondes T et P, en particulier en V3-V4.<\/li><li>espace PR allong\u00e9 &gt; 200ms (zone verte)<\/li><li>QRS large avec aspect de bloc de branche droit<\/li><li>Axe d\u00e9vi\u00e9 \u00e0 gauche \u00e0 -60\u00b0<\/li><li>Trouble de repolarisation en rapport avec le bloc de branche droit<\/li><\/ul>\n\n\n\n<p>=&gt; BAV 1 + BBDt + HBAG (QRS \u00e9largi + d\u00e9viation axiale hyper gauche) : bloc trifasciculaire<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Pr\u00e9sentation &#8211; Bloc fasciculaire<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">D\u00e9finition<\/h3>\n\n\n\n<p>Les blocs fasciculaires sont des bloc infra nodaux en rapport avec l&#8217;atteinte de l&#8217;un des trois faisceaux du r\u00e9seau hissien.<\/p>\n\n\n\n<p>On distingue donc :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Bloc de branche droit (BBD) : atteinte de la branche droite<\/li><li>Bloc de branche gauche (BBG) : l\u00e9sion des 2 faisceaux de la branche gauche<\/li><li>Atteinte isol\u00e9e de l&#8217;une des branches gauches (H\u00e9mibloc)<ul><li>Faisceau ant\u00e9rieur gauche = bloc fasciculaire ant\u00e9rieur gauche (BFAG) : QRS &lt; 120 ms et axe d\u00e9vi\u00e9 \u00e0 gauche &gt; -30\u00b0<\/li><li>Faisceau post\u00e9rieur gauche = bloc fasciculaire post\u00e9rieur gauche (BFPG) : QRS d\u2019environ 120 ms et axe d\u00e9vi\u00e9 \u00e0 droite &gt; + 120\u00b0<\/li><\/ul><\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Bloc bifasciculaire<\/h3>\n\n\n\n<p>Ils concernent l&#8217;interruption de 2 branches parmi les 3 divisions du faisceau de His :<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">BBD + Bloc fasciculaire ant\u00e9rieure gauche (BFAG) <\/h4>\n\n\n\n<ul class=\"wp-block-list\"><li>Fr\u00e9quent dans l\u2019\u00e9volution des cardiopathies mais \u00e9volue rarement vers BAV3<\/li><li>Pas d\u2019indication \u00e0 la pose d\u2019un PM si asymptomatique<\/li><li>Si association avec BAV1 \u2192 possible bloc trifasciculaire et donc exploration n\u00e9cessaire<\/li><\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">BBD + Bloc fasciculaire post\u00e9rieur gauche (BFPG). <\/h4>\n\n\n\n<ul class=\"wp-block-list\"><li>Rare mais \u00e9volue toujours vers BAV3<\/li><li>Indication \u00e0 la pose d\u2019un stimulateur cardiaque<\/li><\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">BBG est un bloc bifasciculaire : BFAG + BFPG <\/h4>\n\n\n\n<ul class=\"wp-block-list\"><li>Pas d\u2019indication \u00e0 la pose d\u2019un PM si asymptomatique, recommand\u00e9 si insuffisance cardiaque<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Bloc trifasciculaire<\/h3>\n\n\n\n<p>Interruption des 3 faisceaux de division du faisceau de His : BBDt, BFAG, BFPG.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Indication \u00e0 la pose d&#8217;un PM devant un risque \u00e9volutif important vers un BAV complet<\/li><\/ul>\n\n\n\n<p>Il peut se manifester sous plusieurs formes :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Alternance BBD complet et BBG complet  <\/li><li>Association BBD complet et h\u00e9mi-bloc ant\u00e9rieur gauche en alternance avec h\u00e9mi-bloc post\u00e9rieur gauche <\/li><li>Association BAV 2 Mobitz II et Bloc de branche complet (droit ou gauche)<\/li><li>Association BAV 2 type I et bloc bifasciculaire complet et permanent <\/li><li>Association BAV 1 et bloc bifasciculaire complet et permanent <\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Bibliographie<\/h2>\n\n\n\n<p>Epstein, Andrew E., John P. DiMarco, Kenneth A. Ellenbogen, N. A. Mark Estes, Roger A. Freedman, Leonard S. Gettes, A. Marc Gillinov, et al. \u00ab\u00a0ACC\/AHA\/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities\u00a0\u00bb. <em>Heart Rhythm<\/em> 5, n<sup>o<\/sup> 6 (juin 2008): e1\u201162. <a href=\"https:\/\/doi.org\/10.1016\/j.hrthm.2008.04.014\">https:\/\/doi.org\/10.1016\/j.hrthm.2008.04.014<\/a>.    <\/p>\n\n\n\n<figure class=\"wp-block-embed-wordpress wp-block-embed is-type-wp-embed is-provider-life-in-the-fast-lane-litfl-medical-blog\"><div class=\"wp-block-embed__wrapper\">\nhttps:\/\/litfl.com\/bifascicular-block-ecg-library\/\n<\/div><\/figure>\n\n\n\n<figure class=\"wp-block-embed-wordpress wp-block-embed is-type-wp-embed is-provider-life-in-the-fast-lane-litfl-medical-blog\"><div class=\"wp-block-embed__wrapper\">\nhttps:\/\/litfl.com\/trifascicular-block-ecg-library\/\n<\/div><\/figure>\n\n\n\n<p><a href=\"https:\/\/www.e-cardiogram.com\/ecg-lexique_theme.php?id_th=6&amp;id_lex=53\">https:\/\/www.e-cardiogram.com\/ecg-lexique_theme.php?id_th=6&amp;id_lex=53<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Interpr\u00e9tation Rythme sinusal et r\u00e9gulier, les ondes P sont parfois confondues \u00e0 l&#8217;onde T laissant apparaitre un aspect d&#8217;onde T bifide en V1-V2. En observant d&#8217;autres d\u00e9rivations on comprend la fusion des ondes T et P, en particulier en V3-V4. espace PR allong\u00e9 &gt; 200ms (zone verte) QRS large avec aspect de bloc de branche &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/admsu.org\/w\/ecg-n12-reponse\/\" class=\"more-link\">Continuer la lecture<span class=\"screen-reader-text\"> de &laquo;&nbsp;ECG n\u00b012 &#8211; R\u00e9ponse&nbsp;&raquo;<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[71,69,70,56,68,72,37],"class_list":["post-287","post","type-post","status-publish","format-standard","hentry","category-ecg-commente","tag-bav-1","tag-bfag","tag-bfpg","tag-bloc-de-branche","tag-bloc-fasciculaire","tag-bloc-trifasciculaire","tag-ecg-commente"],"_links":{"self":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/287","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/comments?post=287"}],"version-history":[{"count":1,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/287\/revisions"}],"predecessor-version":[{"id":289,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/287\/revisions\/289"}],"wp:attachment":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/media?parent=287"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/categories?post=287"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/tags?post=287"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}