We have been developing an externally coupled transcutaneous energy transmission system (ECTETS) for a totally implantable total artificial heart (TITAH). When the ECTETS is unable to supply the energy to drive the TITAH from outside the body, a rechargeable internal back-up battery (RIBB) implanted inside the body is used as a back-up to supply the required energy. This paper reports on the performance characteristics of our ECTETS with an RIBB. In this study, a lithium-ion (Li+) secondary battery was used as the RIBB. The transcutaneous energy transmission and the charging control characteristics of the ECTETS, while simultaneously supplying energy to the TITAH and the RIBB, were evaluated in an in vitro experiment. The output power and transmission efficiency of the ECTETS operating in this mode were found to vary from 20 W to 34 W and from 84% to 71%, respectively. It was also found that a sufficient power of more than 20 W could be supplied to the TITAH. The time needed to fully charge the RIBB was 117 minutes, and a fully charged RIBB could drive the TITAH, consuming 20 W for 62 minutes. It may, therefore, reasonably be concluded that the ECTETS with the RIBB is sufficient to drive the TITAH.