Defibrillator lead dislocation after manual lumbar traction.

To the Editor,

We report a 63-year-old patient with prior coronary artery bypass surgery and recent history of recurrent hospital admissions for refractory heart failure because of ischemic cardiomyopathy and sustained ventricular tachycardia. The patient underwent ICD implantation through left subclavian vein approach (Medtronic, single chamber, model-Maximo II VR, D284VRC, with 6947 ventricular active fixation lead). This case report describes the first patient, to our knowledge, with defibrillator lead dislocation after manual lumbar traction for low back pain. The patient was admitted to the emergency service with severe chest pain, and electrocardiography revealed 0.5–1 mm ST-segment elevation in leads DII, DIII, and aVF. After initial evaluation, coronary angiography and percutaneous coronary intervention were immediately performed with the diagnosis of acute inferior myocardial infarction. Case history revealed ICD implantation 4 months ago because of ischemic cardiomyopathy and sustained ventricular tachycardia. During angiography, abnormal course of the defibrillator lead was noticed (Fig. 1). ICD interrogations revealed a dislocated defibrillator lead with lead impedance over 2.000 ohms and inability to capture, and defibrillator analysis showed no ventricular sensing and pacing. Despite successful primary percutaneous coronary intervention for totally occluded circumflex coronary artery, the patient developed shock and expired the day after. When relatives were questioned, it was learned that the patient had undergone manual lumbar traction by a non-medical person because of low back pain.

Lumbar traction has been used since prehistoric times for spinal disorders. The most commonly used traction technique is manual traction exerted by non-medical persons, using the patient’s body weight to apply force. Manual traction is applied as the non-medical person’s hands and/or belt are used to pull the patient’s legs (1). Traditional lumbar traction force was applied to the thorax in the cephalad direction and to the pelvis and ankles in the caudal direction with the subjects positioned supine (1). Generally, pelvic belt with straps are used for distraction. In our country, non-medical persons commonly use manual lumbar traction as an alternative treatment for low back pain.

Literature search did not reveal any case of pacemaker lead dislodgement after manual lumbar traction. However, there is a case report showing isolated ureter injury after traction for the low back pain (2).