Lumbar medial branch radiofrequency neurotomy in a patient with a leadless pacemaker: a case report

Facet-mediated lumbar pain is commonly treated with radiofrequency neurotomy (RFN) following confirmatory medial branch blocks. Because RFN generates electrical current, concerns exist regarding electromagnetic interference (EMI) in patients with cardiac implantable electronic devices, particularly leadless pacemakers, for which limited procedural guidance is available.

We present the case of an 81-year-old man with chronic low back pain and a right ventricular leadless pacemaker (Medtronic Micra) who underwent lumbar RFN after successful diagnostic blocks. Pre-procedural electrophysiology evaluation confirmed he was not pacemaker dependent, and the device was interrogated without reprogramming. Bipolar lesioning was performed with continuous cardiac monitoring. The procedure was completed without complication, and post-procedural interrogation demonstrated normal device function. The patient reported significant pain relief at follow-up.

This case highlights that lumbar RFN can be safely performed in patients with a leadless pacemaker when a multidisciplinary approach is utilized. Key considerations include confirmation of device type and pacemaker dependency, pre-procedural interrogation, use of bipolar lesioning to reduce EMI risk, and continuous peri-procedural monitoring. As leadless pacemakers become increasingly prevalent, further research is needed to guide specialty-specific recommendations for interventional pain procedures involving radiofrequency-based therapies.