The cardiac pacemaker has been implanted for patients with debilitating low cardiac output associated heart block. Modern technology has provided advanced, controllable and simple cardiac pacemakers throughout the world. The patient with a cardiac pacemaker implanted could give anestheaiolgists many associated problems during the operation and anesthesia. During anesthesia an anesthesiologist should be able to manage the problems which might occur because of a cardiac pacemaker by varicus origins. Authors have experienced a case of open reduction for malunioned femur fracture with a cardiac pacemaker implanted.