A cardiac pacemaker and method of its use. The pacemaker is provided with a pacing electrode array configured for location at a left anterior portion of a patient's thorax between the patients third and sixth ribs, outside the patient's thoracic cavity. The pacing electrode array includes multiple pacing electrodes and preferably includes one or more steering electrodes for configuring the electrical field produced by delivery of pacing pulses to avoid unwanted nerve and muscle stimulation while allowing cardiac stimulation. The electrode array may be located subcutaneously, submuscularly or on the patient's skin.