Unmasking the Dominant Threat of Data Manipulation Attack on Implantable Cardioverter Defibrillators

Implantable Medical Devices (IMDs) have emerged as healthcare assets, profoundly enhancing patients’ quality of life. Although wireless communication in remotely monitored IMDs emphasises its functionalities, it leaves them vulnerable to various security threats. The resource-constrained IMD environment and their unfamiliar access requirements during device or patient emergencies make the adoption of traditional security approaches impractical in this domain. The prevalence of cardiac diseases worldwide has made implantable cardioverter defibrillators (ICDs) one of the most popular IMDs with cutting-edge connectivity and functions. In this paper, we identify the data manipulation attack on ICDs as the most life-threatening attack, which involves the use of malicious clinical programmer. A possible command modification attack scenario is presented which exploits ICDs’ legitimate functionalities. This will assist in developing countermeasures for the identified attack to provide a secure ICD environment.