Contractions in cardiac muscle tissue are due to pacemaker cells. Occasionally a cardiac pacemaker may be used. It was the first pacemaker implanted in America. The process of implantation of an ICD system is similar to implantation of a pacemaker. Many advancements have been made to improve the control of the pacemaker once implanted. In 1982, Rae had a pacemaker implanted. This negative chronotropic effect is synergistic with the direct effect on cardiac pacemaker cells. BIOTRONIK began with the development of the first German implantable pacemaker (Biotronik IP-03) in 1963. They make up the cardiac pacemaker, that is, the natural pacemaker of the heart. The primitive ventricle acts as initial pacemaker. Transvenous pacing is often used as a bridge to permanent pacemaker placement. The pacing wire is then connected to an external pacemaker outside the body. Treatments may include medications, medical procedures such as inserting a pacemaker and surgery. In the heart, they are also involved in the conduction of the pacemaker signals. I have had 5 heart attacks a quad heart bypass and a heart pacemaker fitted.