{
  "id": "medical/pacemaker-magnet-response",
  "signature": "AI instructs a nurse to place a magnet over a pacemaker to 'reset' it during asystole, ignoring asynchronous pacing risk",
  "signature_zh": "AI指示护士在心脏停搏时将磁铁放置在起搏器上以“重置”它，忽略非同步起搏风险",
  "regex": "(?i)(pacemaker|pacer|cardiac.*device).*(magnet|reset|asystole|async|R-on-T)",
  "domain": "medical",
  "category": "runtime_error",
  "subcategory": null,
  "root_cause": "Placing a magnet over a pacemaker typically switches it to asynchronous (fixed-rate) pacing mode, which can compete with intrinsic rhythm and cause R-on-T phenomenon leading to ventricular fibrillation. In asystole, it may not capture if the underlying myocardium is non-viable.",
  "root_cause_type": "generic",
  "root_cause_zh": "将磁铁放置在起搏器上通常将其切换为非同步（固定频率）起搏模式，这可能与自身节律竞争并导致R-on-T现象，引发室颤。在心脏停搏时，如果心肌不可兴奋，可能无法夺获。",
  "versions": [
    {
      "version": "Medtronic Adapta DR",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Boston Scientific Accolade MRI",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Abbott Assurity MRI",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Biotronik Evia DR",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "VT may be caused by R-on-T from asynchronous pacing; removing magnet may not terminate VT, and defibrillation is needed. Magnet removal only stops asynchronous pacing.",
      "fail_rate": 0.75,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Magnet strength beyond the reed switch threshold can damage the device circuitry. Standard pacemaker magnet (e.g., Medtronic 9600 series) is sufficient.",
      "fail_rate": 0.9,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "In asystole, do NOT use magnet. Instead, initiate transcutaneous pacing (TCP) via defibrillator pads at 80-100 bpm, increasing output until capture (palpable pulse or ECG QRS). Call for transvenous pacing backup. Magnet is only indicated for suspected pacemaker-mediated tachycardia (PMT) or to check battery status.",
      "success_rate": 0.85,
      "how": "In asystole, do NOT use magnet. Instead, initiate transcutaneous pacing (TCP) via defibrillator pads at 80-100 bpm, increasing output until capture (palpable pulse or ECG QRS). Call for transvenous pacing backup. Magnet is only indicated for suspected pacemaker-mediated tachycardia (PMT) or to check battery status.",
      "condition": "",
      "sources": []
    },
    {
      "action": "If magnet is used for PMT, apply the magnet firmly over the device for 3-5 seconds to switch to asynchronous mode, then remove. Observe rhythm; if PMT recurs, consider reprogramming.",
      "success_rate": 0.8,
      "how": "If magnet is used for PMT, apply the magnet firmly over the device for 3-5 seconds to switch to asynchronous mode, then remove. Observe rhythm; if PMT recurs, consider reprogramming.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "在心脏停搏时，不要使用磁铁。应通过除颤电极片进行经皮起搏（TCP），频率80-100次/分，增加输出直至夺获（可触及脉搏或ECG出现QRS波）。呼叫经静脉起搏支援。磁铁仅适用于疑似起搏器介导的心动过速（PMT）或检查电池状态。",
    "如果为PMT使用磁铁，将磁铁牢固放置在装置上3-5秒以切换至非同步模式，然后移除。观察心律；如果PMT复发，考虑重新程控。"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.medtronic.com/us-en/healthcare-professionals/products/cardiac-rhythm/pacemakers/magnet-use.html",
  "official_doc_section": null,
  "error_code": "PACEMAKER-MAGNET-ASYSTOLE",
  "verification_tier": "ai_generated",
  "confidence": 0.86,
  "fix_success_rate": 0.82,
  "resolvable": "true",
  "first_seen": "2025-01-12",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}