case_images: PMC11830951_01
case_images: A 12-lead electrocardiogram demonstrating frequent ventricular premature contractions originating from the left ventricle outflow tract.
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case_images: Upon admission, the patient no longer reported chest pain, but frequent PVCs originating from the antero-basal area were observed (Figure 1).
case_images: Post-contrast cardiac magnetic resonance imaging revealing subendocardial late gadolinium enhancement of the anterior basal myocardial segments in basal short-axis view (red arrow).
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case_images: T scanner (Siemens Healthineers Magnetom Sola) identified two localized, well-defined myocardial scars. The first scar was located in the subendocardium of the basal anterior wall, corresponding to the ischaemic event in 2018 (Figure 2).
case_images: Post-contrast cardiac magnetic resonance imaging displaying subendocardial late gadolinium enhancement at the mid infero-septal myocardial segments in four-chamber long-axis view (top) and in mid short-axis view (bottom), precisely at the location of the left bundle branch area pacing lead (red arrows).
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case_images: Interestingly, a second remote intramyocardial scar was found in the mid infero-septal wall of the left ventricle at the site of the LBBAP lead placement (Figure 3), which does not correspond to an ischaemic lesion based on the coronary angiography results and the intramural (not subendocardial) scar pattern observed on cardiac MRI.