Meet The Veep's New Aide

It felt almost routine last saturday when Vice President Dick Cheney entered George Washington University Hospital for treatment of an irregular heartbeat. This was, after all, the third time in seven months the Vice President had been hospitalized, however briefly, for his heart condition. There had been a moment of genuine alarm Friday when the news broke that Cheney was suffering irregular beats in his heart's bottom chambers, or ventricles. They can lead to an immediately life-threatening situation, unlike most of those that start in the top half of the heart. Inevitably, the cable pundits pondered once again whether Cheney was working too hard and needed to slow down. But this hospital visit, unlike the previous two, had been planned in advance. His physicians implanted in his chest a combination pacemaker-defibrillator to prevent more serious problems. Finally, Cheney and his medical team seem to have got ahead of his heart ailment.

At a news conference following the procedure, the Vice President's doctors pronounced the operation a success and declared his prognosis "terrific." "This really is an insurance policy for him," said Cheney's cardiologist, Dr. Jonathan Reiner. "It is very, very likely he will never use this device." Cheney must avoid vigorous upper- body exercise until his incision heals. After that, the only effect on his lifestyle should be that he'll need to use cell phones on the right side of his body to minimize the chance of electronic interference.

As for the delicate matter of whether Cheney is still equal to the rigors of being Bush's man-for-all-portfolios, Reiner said he told Cheney the device shouldn't interfere with his ability to do his job. Cheney had addressed the issue at a press conference the day before. "I don't have any interest in continuing in the post unless I'm able to perform adequately," he told reporters. "And the doctors have assured me that is the case."

The Vice President and the White House communications team are keenly aware of how badly they bungled the news of Cheney's fourth heart attack in November and his angioplasty in March. Cheney gave George W. Bush a heads-up last Tuesday, and the President replied, "It sounds like the right thing to do." The last time the Vice President left for the hospital, he only told Mary Matalin, his communications aide, on the way out the door. This time Matalin had almost a week to put together a presentation to the public. Among its key elements: having Cheney make the announcement--to demonstrate that he's in charge of his health care--and arranging a wide-open press conference after Saturday's procedure, in which Cheney's doctors would take questions for as long as reporters could fling them. Says Matalin: "The more information, the better."

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.