Open Access

Endres Puschner, Christoph Saatjohann, Markus Willing, Christian Dresen, Julia Köbe, Benjamin Rath, Christof Paar, Lars Eckardt, Uwe Haverkamp, Sebastian Schinzel

• Modern implantable cardiologic devices communicate via radio frequency techniques and nearby gateways to a backend server on the internet. Those implanted devices, gateways, and servers form an ecosystem of proprietary hardware and protocols that process sensitive medical data and is often vital for patients’ health. This paper analyzes the security of this Ecosystem, from technical gateway aspects, via the programmer, to configure the implanted device, up to the processing of personal medical data from large cardiological device producers. Based on a real-world attacker model, we evaluated different devices and found several severe vulnerabilities. Furthermore, we could purchase a fully functional programmer for implantable cardiological devices, allowing us to re-program such devices or even induce electric shocks on untampered implanted devices. Additionally, we sent several Art. 15 and Art. 20 GDPR inquiries to manufacturers of implantable cardiologic devices, revealing non-conforming processes and a lack of awareness about patients’ rights and companies’ obligations. This, and the fact that many vulnerabilities are still to be found after many vulnerability disclosures in recent years, present a worrying security state of the whole ecosystem.