Readers who have followed the early content of “Healthy Heartbeat” will remember that the editors responsible for this platform are front-line clinicians. When introducing pacing therapy to patients, the most frequently asked question is: Is it better to have a pacemaker imported or domestic? Is it better to have a German or an American-made one? Before answering this question, let me introduce the basic structure and function of my pacemaker. As we know, as the name suggests, a permanent pacemaker needs to be permanently buried in the human body, so the requirements for its shape and function are quite demanding, which are summarized as small, light, thin, long-lasting and multifunctional. As mentioned in the previous issue, the pacemaker is a complete system consisting of the pacemaker body (pulse generator) and the electrode leads. The pulse generator is the “power” part of the entire pacing system and consists of a titanium housing with internal circuitry and batteries. The electrical part of the pacemaker determines when the pulses are sent. Each pacing pulse is actually a tiny electrical pulse, which is supplied by a tiny, sealed, high-performance battery. The entire pulse generator acts as a highly sophisticated microcomputer, constantly converting the battery energy into tiny electrical pulses that are not felt by the patient, and controlling the timing and amount of electrical energy released through the circuitry. Due to the existing technical constraints, the batteries in the pulse generator are disposable and need to be replaced by another surgery when they are close to depletion after about 7-10 years. In recent years, pacemakers are becoming smaller, lighter, and more streamlined than ever before through the use of microelectronics and smoother, lighter metals. The pacing electrode lead is an insulated section of wire that is connected to the pacemaker body. Its head end is inserted into the right atrium and right ventricle via a vein in the upper part of the body and contacts the endocardial surface. The tip of the electrode is made into an umbrella, barbed or spiral shape in order to be firmly attached to the endocardial surface. To accommodate the bending and twisting of the body and the beating of the heart itself, the pacing electrode lead is made very flexible. It has two main functions: 1) Transmitting the tiny electrical impulses sent from the pacemaker to the heart. 2. Transmitting the electrical activity of the heart back to the pacemaker and analyzing it for proper pacemaker operation. So how do I restore the rhythm of the human heart after implantation? When I think that a patient’s heart is too slow and needs to be paced, the pulse generator transmits a small electrical signal to the heart through the pacing electrode leads, which is called a pacing pulse. I also monitor the heart’s natural rhythm through the electrode leads, and when I sense that the heart is able to maintain its natural rhythm, I do not send any more pulses, but rather act as a silent observer. Since I am implanted in the body, I need to be at the patient’s service all the time, so my reliability is 100%. This means that only a few countries and companies in the world are able to develop and manufacture me and my brothers and sisters. Therefore, all pacemaker brands and models that have been approved for marketing in our country and are available to physicians and patients have passed the most stringent certification and quality control. The differences between us are in form factor, battery capacity and the addition or subtraction of some specific features. Therefore, there is no need to get hung up on which country or brand of pacemaker to choose. It is important to listen to your physician’s advice and choose the right pacemaker for you.