ICD Security Risks: More Fiction Than Fact

Implantable defibrillators reset erratic heartbeats
heart with heartbeat

A recent Homeland television episode dramatized the fictitious assassination of the U.S. vice president. The diabolical method: hacking into the remote device that controlled the vice president’s implantable defibrillator.

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In a real-world parallel, former U.S. Vice President Dick Cheney admitted in a television interview that his fear of assassination led him to ask his physician to disable the remote device on his implantable cardioverter defibrillator.

This revelation caused a stir in the public, and raised some questions about security. For the 99 percent in the U.S., though, the risks of cyber-cardiac tampering are astronomically low.

Remote device

Implantable cardioverter defibrillators (ICDs) save lives when a fatal arrhythmia occurs. A “shock” sent to the heart resets the heartbeat and restores normal blood flow.

Doctors use a remote device to monitor how well the device is functioning once a patient goes home. They cannot alter or adjust the ICD by using the device.

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Potential for targeted harm

As is the case with any remote, electronic device, the potential for hacking does exist, though the safeguards against such an attempt are very sophisticated and very difficult to override. 

Bruce Wilkoff, MD, staff cardiologist, Director of Cardiac Pacing and Tachyarrhythmia Devices and Associate Section Head of the Pacing and Electrophysiology Section at Cleveland Clinic, explains, “The ability to communicate with the defibrillator has many significant security protections. While it is within the realm of possibilities to change the function of the ICD so it is less supportive of the patient’s condition or even to harm a patient, there are great limits to this potential vulnerability as the telemetry signal cannot be transmitted long distances.” Dr. Wilkoff further explains, “There are two types of remote devices, one with a short range (just a few inches) and the other with a longer range (up to about 20 feet).”

Suspension of disbelief

The television plot ignores the fact that anyone who could get close enough to their intended target in order to disrupt or disable the ICD would have ample opportunity to do harm in other simpler and more directly lethal ways.

The act of turning off the remote device doesn’t provide any real meaningful protection, says Dr. Wilkoff, but if the vice president was very fearful, then the alteration might have helped his peace of mind. “The benefit would have been more one of reassurance rather than real protection,” he says.

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Common sense should rule

You should not worry about your ICD and its remote features that permit your doctor to monitor your health. Even high-profile executives have little to fear. There are many layers of protection on these devices and manufacturers are beefing up security even more, perhaps in reaction to the public revelations about Dick Cheney’s security concerns. 

“The Cleveland Clinic uses these types of capabilities to follow about 60,000 patients around the world from their homes, and of course, with their permission. We are able to listen to but not change the behavior of their devices and provide substantial reassurance and reduced travel and reduced expense,” Dr. Wilkoff says. “We can provide better and more comprehensive care with these features.” 

Dr. Wilkoff assures the most imaginative of cardiac patients, “For the average person, the benefits of more remote communication with an ICD far exceed any imagined risk.”

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