Abstract
The occurrence of pacemaker-related malfunction resulting from firmware updates is rare. The estimated risk of reloading of previous firmware due to incomplete update is 0.161%, loss of programmer device settings is 0.023%, and complete loss of device functionality is 0.003%, as informed by the manufacturer.1 Recently, Abbott Medical released a software patch that updates firmware to patch cybersecurity vulnerabilities. Because to date there have been no known instances of successful hacking of a pacemaker system or instances of clinical harm, the risk associated with a firmware update must be balanced against the theoretical risk of a cybersecurity vulnerability. Here we report the occurrence of malfunctions encountered during pacemaker interrogation of 3 Abbott pacemakers associated with the version 23.1.1 Abbott firmware update. The firmware update affected programmers, wireless pacemakers, and Merlin.Net remote monitoring devices, and was designed to address cybersecurity and premature battery depletion issues.1
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