Elsevier

Heart Rhythm

Volume 18, Issue 3, March 2021, Pages 473-481
Heart Rhythm

Contemporary Review
Cybersecurity: The need for data and patient safety with cardiac implantable electronic devices

https://doi.org/10.1016/j.hrthm.2020.10.009Get rights and content

Remote monitoring of cardiac implantable electronic devices (CIEDs) has become routine practice as a result of the advances in biomedical engineering, the advent of interconnectivity between the devices through the Internet, and the demonstrated improvement in patient outcomes, survival, and hospitalizations. However, this increased dependency on the Internet of Things comes with risks in the form of cybersecurity lapses and possible attacks. Although no cyberattack leading to patient harm has been reported to date, the threat is real and has been demonstrated in research laboratory scenarios and echoed in patient concerns. The CIED universe comprises a complex interplay of devices, connectivity protocols, and sensitive information flow between the devices and the central cloud server. Various manufacturers use proprietary software and black-box connectivity protocols that are susceptible to hacking. Here we discuss the fundamentals of the CIED ecosystem, the potential security vulnerabilities, a historical overview of such vulnerabilities reported in the literature, and recommendations for improving the security of the CIED ecosystem and patient safety.

Keywords

Cardiac implantable electronic device
Cybersecurity
Data security
Hacking
Remote monitoring

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Funding sounces: The authors have no funding sources. Disclosures: The authors have no conflicts of interest to disclose.

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