Lumbar Compression Fracture Caused by Cardioversion

Patient: Male, 46-year-old Final Diagnosis: Lumbar compression fracture Symptoms: Low back pain Medication:— Clinical Procedure: Cardioversion Specialty: Family Medicine OBJECTIVE: Diagnostic/therapeutic accidents BACKGROUND: Cardioversion is a safe, commonly used procedure throughout the world. It is performed over 30 000 times per year in the United States, specifically for atrial fibrillation. Procedural risks from cardioversion include clot dislodgement, sedation effects, site pain, burns, hypotension, dysrhythmias, or heart failure. Generally, back pain is considered to be simple muscle soreness, and cardioversion consents therefore do not include discussion of back injuries. CASE REPORT: A 46-year-old man with no prior back pain or injury history underwent a planned synchronized cardioversion for atrial fibrillation. He immediately reported new back pain following the procedure. No unusual event such as a fall occurred near the time of the procedure, but upon evaluation, he was found to have a new lumbar compression fracture that caused incapacitating pain for more than 6 weeks. CONCLUSIONS: Cardioversion has been found to be a safe, effective treatment for atrial fibrillation. Adverse effects are generally minor, and the frequency of adverse effects appear to be low overall. The case reported here represents a rare, but possibly underreported adverse effect, namely, lumbar compression fracture due to cardioversion. Patients should be counseled on the possibility of back injury, even compression fracture, as a result of cardio-version. It would also be prudent to broaden the differential diagnosis possibilities should a patient complain of back pain after cardioversion.