ABSTRACT
Introduction: The electrophysiology field has progressed rapidly over the last 2 decades. No study has examined the characteristics of patients and types of electrophysiology procedures performed in the Kingdom of Saudi Arabia. This is important given our distinctly different demographic composition and health system. As such, we sought to describe the characteristics of consecutive patients presenting for electrophysiology procedures in our tertiary care hospital. Methods: Data was collected from the electrophysiology database at King Khalid University Hospital for procedures performed between April 2016 and November 2022. Patients' characteristics were retrieved from the electronic medical record. Procedures were categorized into supraventricular tachycardia, premature ventricular contraction and "complex ablations", which included atrial fibrillation and scar-mediated ventricular tachycardia ablation. If no abnormality was found, the procedure was labeled as "normal EP study". Multivariate regression analysis was performed to assess predictors of atrioventricular nodal reentry tachycardia among patients presenting with undifferentiated supraventricular tachycardia. Results: A total of 459 patients were included in the study. The mean age was 42.06 years (±14.89 years), and 256 (55.77 %) were females. The most common procedure was supraventricular tachycardia (n = 289/459, 63.24 %), and only 5 % had complex ablations. The most common type of supraventricular tachycardia ablated was found to be atrioventricular nodal reentry tachycardia (n = 157/289, 54 %). Multivariate logistic regression revealed female sex and age to be independently associated with atrioventricular nodal reentry tachycardia (OR = 2.27 95 % CI [1.40-3.67]) for female sex and (OR = 1.02 95 % CI [1.01-1.04]) for every increase in age by 1-year. Conclusion: We reported a younger average age than other countries and less complex ablations. In addition, we reported 2 independent predictors of atrioventricular nodal reentry tachycardia in patients presenting with undifferentiated supraventricular tachycardia. Larger studies including multiple centers should be performed to confirm our findings.
ABSTRACT
Cerebrospinal fluid (CSF) rhinorrhea is rarely reported as the first presenting feature of giant invasive macroprolactinomas. Cerebrospinal fluid rhinorrhea is usually reported as a complication of trauma, neurosurgical, and skull-based procedures (such as pituitary surgery or radiations), and less frequently after medical treatment with dopamine agonists (DAs) for macroprolactinomas. This phenomenon results from fistula creation that communicates between the subarachnoid space and the nasal cavity. Meanwhile, pneumocephalus is another well-recognized complication after transsphenoidal surgery for pituitary macroadenomas. This entity may present with nausea, vomiting, headache, dizziness, and more seriously with seizures and/or a decreased level of consciousness if tension pneumocephalus develops. Case reports about the occurrence of spontaneous pneumocephalus after medical treatment with DAs without prior surgical interventions are scarce in the literature. Our index case is a young man who was recently diagnosed with a giant invasive prolactin-secreting pituitary macroadenoma with skull base destruction. A few months before this diagnosis, he presented with spontaneous CSF rhinorrhea with no history of previous medical or surgical treatment. In this case report, we report an uncommon presentation for giant invasive macroprolactinoma with a CSF leak treated with cabergoline that was subsequently complicated by meningitis and pneumocephalus. This is a very rare complication of cabergoline therapy, which occurred approximately 1 month after treatment initiation.
