CONEXUS TELEMETRY AND MONITORING ACCESSORIES SECURITY BULLETIN

March 21, 2019
Updated: June 3, 2021

Medtronic has released a final update to address these vulnerabilities in a subset of devices listed below.

Protecta™ Cardiac Resynchronization Therapy Defibrillator (CRT-D) and Implanted Cardiac Defibrillator (ICD), all models

Additionally, updates for Amplia MRI™ CRT-D, all models; Claria MRI™ CRT-D, all models; and Compia MRI ™ CRT-D, all models; are now available worldwide where approved by local regulators.

The complete updated advisory issued by CISA, can be found here.

March 21, 2019
Updated: April 8, 2021

Medtronic has released a final update to address these vulnerabilities in a subset of devices listed below.

Protecta™ Cardiac Resynchronization Therapy Defibrillator (CRT-D) and Implanted Cardiac Defibrillator (ICD), all models

The complete updated advisory issued by CISA, can be found here.

March 21, 2019
Updated: June 04, 2020

Medtronic has released an update to address these vulnerabilities in a subset of devices listed below.

Amplia MRI™ CRT-D, all models (update released in US only)
Claria MRI™ CRT-D, all models (update released in US only)
Compia MRI™ CRT-D, all models (update released in US only)
Visia AF MRI™ ICD, all models (update released worldwide)
Visia AF™ ICD, all models (update released worldwide)­ ­

To date, no cyberattack, privacy breach, or patient harm has been observed or associated with these vulnerabilities.

The complete updated advisory issued by ICS-CERT, can be found here.

Updated: January 30, 2020

Medtronic has released an update to address these vulnerabilities in a subset of the devices listed below.

Brava™ CRT-D, all models
Evera MRI™ ICD, all models
Evera™ ICD, all models
Mirro MRI™ ICD, all models
Primo MRI™ ICD, all models
Viva™ CRT-D, all models

Original Bulletin: March 21, 2019

VULNERABILITY SUMMARY

External security researchers Peter Morgan of Clever Security and Dave Singelée and Bart Preneel of KU Leuven, Eduard Marin formerly of KU Leuven and currently with the University of Birmingham, Flavio D. Garcia, Tom Chothia of the University of Birmingham and Rik Willems of University Hospital Gasthuisberg Leuven disclosed potential cybersecurity vulnerabilities in some Medtronic products. The vulnerabilities apply to the proprietary Medtronic Conexus™ radio frequency wireless telemetry protocol (referred to “Conexus telemetry” in this document) associated with some Medtronic ICDs (implantable cardioverter defibrillators) and CRT-Ds (cardiac resynchronization therapy defibrillators). A complete list of affected products is at the end of this document.

Conexus telemetry is not used in Medtronic pacemakers (including those with Bluetooth^® wireless functionality). Additionally, CareLink Express monitors and the CareLink Encore programmers (Model 29901) used by some hospitals and clinics do not use Conexus telemetry.

Conexus telemetry allows Medtronic programmers and monitoring accessories to:

• Remotely transmit data from a patient’s implanted cardiac device to a specified health care clinic (i.e. remote monitoring), including important operational and safety notifications.
• Display and print device information in real time for clinicians.
• Program device settings.

The vulnerabilities could allow an unauthorized individual (i.e. someone other than a health care professional) to access and potentially change the settings of an implantable device, home monitor or clinic programmer. Medtronic is conducting security checks to look for unauthorized or unusual activity that could be related to these vulnerabilities.

Taking advantage of these vulnerabilities in order to cause harm to a patient would require detailed knowledge of medical devices, wireless telemetry and electrophysiology. Exploitation is also more difficult because:

• During the implant procedure and in-clinic follow-up visits, Conexus telemetry must be activated by a health care professional who is in the same room as the patient
• Outside of the hospital/clinic activation times are limited, vary by patient, and are difficult to be predicted by an unauthorized user.
• An unauthorized individual would need to be close to an active device, monitor, or clinic programmer to take advantage of these vulnerabilities. Depending on the surrounding environment, the typical maximum communications range between an active device and a monitor or programmer does not exceed 6 meters (20 feet).

Mitigation

Medtronic is developing updates to mitigate these vulnerabilities. We will inform patients and physicians when they become available (subject to regulatory approvals).

Medtronic recommends that patients and physicians continue to use these devices as prescribed and intended. The benefits of remote monitoring outweigh the practical risk that these vulnerabilities could be exploited. These benefits include earlier detection of arrhythmias, fewer hospital visits and improved survival rates.

Patients with concerns about these cybersecurity vulnerabilities should discuss these concerns with their physicians.

The complete updated advisory issued by ICS-CERT can be found here.

Products Affected

Devices and Accessories utilizing Conexus telemetry include:

*Not all devices are approved or distributed in all geographies.

Q&A:

Q: What was done to address these vulnerabilities?
A: Medtronic decreased the attack surface area of the devices and reduced the window of time in which Telemetry C is active. IT security professionals may contact Medtronic cybersecurity team if they have additional questions Patient Technical Services at 855-275-2717.

As part of our ongoing vigilance, Medtronic is conducting security checks to look for unauthorized or unusual activity related to these vulnerabilities.

Q: How are these updates being implemented to patient devices?
A: A patient’s device will automatically receive the updated software during device interrogation at their next clinic visit.

Q: How do patients know if their device has been updated?
A: Patients should contact their physician to determine if their device has been updated.

Q: Why did the FDA issue a safety alert about this issue?
A: Medtronic disclosed vulnerabilities related to the proprietary wireless communication technology (Conexus telemetry) associated with certain Medtronic ICDs and CRT-Ds and programmers. We have also shared guidelines to mitigate cybersecurity risks related to Conexus telemetry.

Q: What is the practical risk to a patient?
A: Even though an unauthorized user may be able to access the Conexus telemetry, that access does not mean the unauthorized user will have the ability to control or change the settings of an implanted heart device. Fully exploiting these vulnerabilities requires comprehensive and specialized knowledge of medical devices, wireless telemetry and electrophysiology. These vulnerabilities are not accessible from the Internet.

To date, neither a cyberattack nor patient harm has been observed or associated with these vulnerabilities.

Q: What should a patient do next?
A: Medtronic recommends that patients and physicians continue to use devices as prescribed and intended. The benefits of remote monitoring outweigh the practical risk that these vulnerabilities could be exploited. The following guidelines should be used to further reduce the risk of these vulnerabilities:

• Use only the remote monitor obtained directly from a healthcare provider or Medtronic. This helps to ensure integrity of the system.
• Continue to keep the remote monitor plugged in at all times.
• The remote monitor must remain powered up to ensure any wireless CareAlerts™ programmed by the physician and/or any automatically scheduled remote transmissions occur.
• Maintain good physical control over the remote monitor.
• Report any concerning behavior regarding these products to a healthcare provider or to Medtronic.

Patients with concerns about these cybersecurity vulnerabilities should discuss these concerns with their physician.

Medtronic Contact Information

US: Medtronic Patient and Technical Services is available to answer questions Monday-Friday 7am – 6pm central time at 855-275-2717.

International: Contact your local Medtronic representative.