Abstract: A pacemaker system for a heart having an external muscle is used to control pacing of the heart during normal or even arrhythmic modes. In these modes, the muscle is stimulated synchronously with the heart to augment the heart's cardiac functions. When the heart undergoes ventricular fibrillation, the muscle is provided with a signal to cause the muscle to contract and expel blood from the heart chambers. Defibrillation shock is then applied to the heart to halt the fibrillation. The system is rendered more effective, safer and uses less power because the defibrillating energy is efficiently transferred to the heart muscles and not to the blood contained in its chambers. The system includes a microprocessor, muscle stimulating circuitry, defibrillation circuitry and an interface for exchanging signals between the microprocessor and the remaining components.