1, 2 In view of this and the demonstrated reduction of in-person visits, the burden on physicians and clinics, and the established reimbursement for remote services, there has been increasing adoption of RM into medical practice. Several studies have shown that remote monitoring (RM) of these devices improves patient outcomes, survival, and hospitalizations, and is being recommended as standard of care in multiple consensus statements and guidelines published by the Heart Rhythm Society (HRS). Once the physician/care team reviews the uploaded data, they can reach out to the patient to discuss necessary treatment options. Starting from the patient, information uploaded from the patient’s CIED to the home monitoring system is transmitted to a central archiving system, which then uploads the information to the physician’s office. Schematic diagram showing how remote information is transmitted from a patient’s cardiac implantable electronic device (CIED) to the health care provider. 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.
Various manufacturers use proprietary software and black-box connectivity protocols that are susceptible to hacking. The CIED universe comprises a complex interplay of devices, connectivity protocols, and sensitive information flow between the devices and the central cloud server.
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. However, this increased dependency on the Internet of Things comes with risks in the form of cybersecurity lapses and possible attacks. 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.