CardiWall: a trusted firewall for the detection of malicious clinical programming of cardiac implantable electronic devices

Matan Kintzlinger, Aviad Cohen, Nir Nissim, Moshe Rav-Acha, Vladimir Khalameizer, Yuval Elovici, Yuval Shahar, Amos Katz

IEEE Access 8, 48123-48140, 2020

Today, cardiac implantable electronic devices (CIEDs), such as pacemakers and implantable cardioverter defibrillators (ICDs), play an increasingly important role in healthcare ecosystems as patient life support devices. Physicians control, program and configure CIEDs on a regular basis using a dedicated programmer device. The programmer device is open to external connections (e.g., USB, Bluetooth, etc.), and thus it is exposed to a variety of cyber-attacks by which an attacker can manipulate the programmer device’s operations and consequently harm the patient. In this paper, we present CardiWall, a novel detection and prevention system designed to protect ICDs from cyber-attacks aimed at the programmer device. Our system has six different layers of protection, leveraging medical experts’ knowledge, statistical methods, and machine learning algorithms. We evaluated the CardiWall system extensively in two …