{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T10:26:09Z","timestamp":1793701569981,"version":"4.5.1"},"reference-count":0,"publisher":"Sultan Qaboos University","issue":"5","license":[{"start":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T00:00:00Z","timestamp":1701302400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sultan Qaboos University Medical Journal"],"abstract":"<jats:p>Temporary epicardial cardiac pacing in patients with bradyarrhythmias may be used as a bridge to implantation of a permanent pacemaker. The temporary epicardial lead placement may sometimes necessitate a sternotomy that may pose a challenge in patients who have had multiple earlier sternotomies. The difficulty in accessing the epicardium for urgent implantation of temporary epicardial pacing leads depends on the extent of adhesions in such patients. We report an 8-year-8-month-old girl with a pacemaker with an extruded pulse generator and difficult myocardial access due to 5 prior transsternal procedures. The child presented to a tertiary care hospital in Muscat, Oman, in 2021. A trouble-shooting technique was adopted to achieve temporary epicardial pacing to provide time for a course of antibiotic therapy administration. A permanent transvenous pulse generator system was implanted after 7 days of temporary pacing.<\/jats:p>","DOI":"10.18295\/squmj.12.2023.079","type":"journal-article","created":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T22:23:13Z","timestamp":1701555793000},"page":"55-58","source":"Crossref","is-referenced-by-count":0,"title":["Troubleshooting During Temporary Epicardial Lead Implantation in a Child with an Erosive Twiddler\u2019s Syndrome and Multiple Sternotomies: &lt;i&gt;A case report&lt;\/i&gt;"],"prefix":"10.18295","volume":"23","author":[{"given":"Madan M","family":"Maddali","sequence":"first","affiliation":[{"name":"Department of Cardiac Anesthesia, National Heart Center, The Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail A","family":"Al-Abri","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malay H","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesia, National Heart Center, The Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr M","family":"Abokwafa","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, National Heart Center, The Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunny","family":"Zacharias","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, National Heart Center, The Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"7681","published-online":{"date-parts":[[2023,11,30]]},"container-title":["Sultan Qaboos University Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.squ.edu.om\/index.php\/squmj\/article\/download\/6167\/3974","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.squ.edu.om\/index.php\/squmj\/article\/download\/6167\/3974","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T09:31:26Z","timestamp":1793698286000},"score":1,"resource":{"primary":{"URL":"https:\/\/mjournal.squ.edu.om\/home\/vol23\/iss5\/10"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,30]]},"references-count":0,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,11,30]]}},"URL":"https:\/\/doi.org\/10.18295\/squmj.12.2023.079","relation":{},"ISSN":["2075-0528"],"issn-type":[{"value":"2075-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,30]]}}}