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This page in Cheney's cardiovascular diary began a few weeks ago, when Reiner decided to check the Vice President for irregular heartbeats, or arrhythmia. By all accounts, Cheney hadn't exhibited any symptoms--no dizziness or fainting spells that might indicate a problem. But roughly 5% of people who suffer heart attacks develop arrhythmias, often without realizing it. This is particularly common among patients like Cheney, whose "ejection fraction," a measure of how efficiently the heart is pumping, is around 40%. Usually the problem occurs because some scar tissue in the heart muscle starts to interfere with the electrical signals that cause the organ to beat.
Over Father's Day weekend, Cheney strapped on a Holter monitor--basically a portable ECG machine--to produce a 34-hr.-long recording of his heartbeat. The monitor revealed four distinct episodes, each lasting just a second or two, in which the ventricles of his heart beat too fast. The situation is dangerous only if it becomes permanent. "The heart doesn't actually stop," says Dr. Eric Prystowsky, president of the North American Society of Pacing and Electrophysiology. "But it beats so fast that no blood can flow through its chambers." Unless a normal rhythm is re-established, death follows quickly. Cheney's doctors realized they would have to intervene.
In the past two years, two major studies have shown that patients with a medical history similar to Cheney's whose ventricles also beat irregularly are much less likely to die suddenly if a device called an implantable cardioverter defibrillator (ICD) is placed under the skin below their collarbone. The device monitors the heartbeat and emits electrical signals to slow down or speed up the heart as needed (see box).
When Cheney entered the hospital last Saturday just after 8 a.m., doctors gave him a mild sedative, then threaded a wire through one of the veins in his right leg up to his heart. By sending different electrical pulses through the wire, the physicians succeeded in re-creating the irregular heartbeats that were picked up by the Holter monitor. Then they figured out where to place the lead wires from the ICD to ensure that it would deliver the correct voltage to the appropriate spots on the heart whenever the heart needed to resume a normal beat.
The Vice President was expected back at the office on Monday. But the fact is Bush doesn't need Cheney quite as much as he used to. Bush has been President for almost six months now. He may still be learning, but he can't help being more confident and competent than he was on Jan. 21. That's not to say Cheney isn't an immensely powerful player in the Administration. His reach extends famously from foreign policy and defense to energy, antiterrorism, congressional relations and more. But Cheney's star has dimmed ever so slightly since his dismissive remark about conservation being a "personal virtue" rather than effective policy. He helped make Bush seem out of touch.
Speculation is rampant about who would succeed Cheney if he doesn't finish his first term or declines to run for re-election. Would Bush go with Colin Powell--a bold move that would infuriate the right but help draw moderates and African-Americans into the G.O.P.? With the Senate closely divided, the White House would surely be loath to tap one of the 49 G.O.P. members.