A Vertebral Fracture During Cardioversion for Atrial Fibrillation: A Case Report and Revision of the Literature

Introduction: Cardioversion for atrial fibrillation (AF) is considered a well-known and safe procedure. However, there are potential complications described associated to this procedure. Bone sequalae or fractures are not cited in consent forms neither in Italy nor in the United States. Nevertheless, cases of vertebral fractures have been reported after multiple defibrillations for ventricular tachycardia and all these cases involved relatively young patients. Case Report: We present the case of a 44-year-old Caucasian male patient with no comorbidities who underwent cardioversion to restore sinus rhythm from AF. The patient complained of acute dorsal back pain immediately after the cardioversion procedure. The patient informed the cardiologist about the back pain, but no clear explanation for the symptom was provided. Three weeks later, the patient underwent a magnetic resonance and was subsequently diagnosed with a cardioversion procedure-related sixth thoracic (T6) vertebral body fracture. Conclusion: Vertebral compression fracture should be included in the differential diagnoses for severe back pain after cardioversion procedures. Investigation with standard X-ray or, in doubt, with a magnetic resonance imaging of the painful segment is advisable. In addition, this possible complication should be considered in the informed cardiological consent for the cardioversion procedure even though extremely rare. Keywords: Vertebral fracture, electrical cardioversion, atrial fibrillation, acute back pain.