Security Analysis of Cardiovascular Implantable Electronic Device (CIED) using a Threat Model-based Approach

Cardiovascular implantable electronic devices (CIEDs) have become an effective and popular treatment for patients with certain heart conditions. CIEDs are widely adopted by the medical community and millions of patients have such devices implanted in their bodies. However, many security and privacy issues remain in CIEDs which have the potential to harm patients. Due to the uniqueness of CIED security vulnerabilities and the lack of systematic security analysis, a proper trustworthy system is difficult to design. A threat model is a procedural approach that can identify, quantify, and prioritize threats, vulnerabilities, and remediation methods. It is used to identify malicious threat agents that are harmful to both systems and devices. In this paper, we have analyzed the CIED security issues and threat model using the STRIDE and the foundational security principles — Confidentiality, Integrity, Availability, and Authentication (CIAA). Our analysis has identified some CIED-specific threats and vulnerabilities. Additionally, we have identified a set of countermeasures and mitigation strategies to make CIEDs more secure.