Kapoor Aditya, Vora Amit, Yadav Rakesh
Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
Arrhythmia Associates, Mumbai, India.
Indian Heart J. 2019 Nov-Dec;71(6):427-430. doi: 10.1016/j.ihj.2020.02.001.
Cardiac implantable electronic devices (CIEDs) include bradycardia pacemakers, defibrillators, and cardiac resynchronization therapy devices. These devices are proven to save lives and improve quality of life in indicated patients. Recent advances in CIED technology allow interrogating and transmitting data stored in these devices wirelessly through radiofrequency or Bluetooth technology and more recently through smartphones. Remote monitoring of CIED uses telemetry and IP connectivity to transmit data from devices to the cloud and eventually to hospitals/clinics monitoring them. There has been overwhelming evidence in support of remote monitoring of CIEDs, improving patient outcomes, survival, and hospitalization. Therefore, guidelines recommend remote monitoring for all CIEDs. Remote monitoring allows frequent checks reducing clinic visits, improving efficiency of medical resources and timely intervention in patients with clinical events. Although internet of things (IOT) dependency is increasing, advantages of connectivity and data transfer come with a price of hacking, resulting in malfunction of computers, misuse of stolen data, or medical extortion. Therefore, cybersecurity has become a necessity in this digital world. Medical devices using net connectivity expose themselves to cyber attacks. Fortunately so far no hacking or cyber attack has been reported in patients with CIEDs, and most literature focuses on proof of concept and in-the-research laboratory scenarios. Although documented clinical events have not yet happened, the threat is real. It is essential to be well prepared for this potential but serious threat. It is imperative that device manufacturers, regulatory bodies, medical professionals, and patients all work together to prevent, identify, and mitigate cyber threat.
心脏植入式电子设备（CIEDs）包括心动过缓起搏器、除颤器和心脏再同步治疗设备。这些设备已被证明能挽救生命并改善特定患者的生活质量。CIED技术的最新进展使得可以通过射频或蓝牙技术，以及最近通过智能手机，无线查询和传输存储在这些设备中的数据。CIED的远程监测利用遥测和IP连接将数据从设备传输到云端，并最终传输到监测它们的医院/诊所。有大量证据支持CIED的远程监测，这能改善患者预后、生存率和住院情况。因此，指南建议对所有CIED进行远程监测。远程监测允许频繁检查，减少门诊就诊次数，提高医疗资源利用效率，并能对发生临床事件的患者进行及时干预。尽管对物联网（IOT）的依赖在增加，但连接性和数据传输的优势伴随着黑客攻击的风险，可能导致计算机故障、被盗数据的滥用或医疗敲诈。因此，网络安全已成为这个数字世界中的一项必要措施。使用网络连接的医疗设备容易受到网络攻击。幸运的是，到目前为止，尚未有关于CIED患者遭受黑客攻击或网络攻击的报道，并且大多数文献关注的是概念验证和研究实验室场景。尽管尚未记录到临床事件，但威胁是真实存在的。必须为这种潜在但严重的威胁做好充分准备。设备制造商、监管机构、医疗专业人员和患者必须共同努力，以预防、识别和减轻网络威胁。
