Vice President Cheney back to work after ICD implant over the weekend

Susan Jeffrey

July 02, 2001

Mon, 02 Jul 2001 21:00:00

Washington, DC - Vice President Dick Cheney is back to work at the White House today after electrophysiology (EP) testing on June 30, 2001 showed a clear need for implantation of an implantable cardioverter defibrillator (ICD), and the procedure was carried out. At a press conference afterward at George Washington University Hospital (Washington, DC), his doctors were very upbeat about Cheney's prognosis, but news reports raised the issue of what this means for his performance in office.

Drs Reiner, Wasserman, and Yee describe the ICD implantation to reporters (Source: George Washington University Hospital)

During the EP testing, which was performed by Dr Sung W Lee (George Washington University Hospital), Cheney was found to be an obvious candidate for ICD implantation. "In the electrophysiology laboratory, a very short fast run of the kind of tachycardia that we were looking for was able to be induced," said Dr Jonathan S Reiner, chairman of the GW cardiac catheterization laboratory and Cheney's personal cardiologist told the press conference Saturday. "Dr Lee terminated it very rapidly with just the insertion of a pacemaker beat, and the presence of that kind of inducibility of that type of fast heartbeat, really made the treatment straightforward," he said.

"If those beats can be induced, we really know with certainty and with clarity that the kind of device that the vice president received is really the straightforward treatment option, and outcomes really are terrific following the placement of that," Reiner added.

Lee described the induced episodes of VT as "quite fast, and fast enough that it would lower his blood pressure."

Otherwise, Reiner defined his patient's overall condition as, "remarkably stable," noting that he functions physically on a "completely asymptomatic, very high level." Cheney's ejection fraction (EF) is "about 40%, his blood pressure (BP) is normal and his LDL is "as low as I've ever seen it," at 72 mg/dL, Reiner added.

Cheney reaps benefits of recent data

The decision to go ahead with EP testing was based on findings of ambulatory Holter monitoring carried out about 2 weeks ago, which showed 4 separate short episodes of tachycardia.

Reporters at the GW press conference on June 30, 2001 asked Reiner why there had been such a delay between Cheney's last Holter monitoring in 1988, around the time of his bypass surgery, and the current testing.

Reiner replied that the data upon which current practice in this type of patient is based is still quite new. In the 1990s, the focus had been on how to deal with patients who already have symptoms. "What we've learned in the last couple of years, really the last year, year and a half, from large scale trials that have evaluated patients such as the vice president, [is] the value of evaluating patients who don't have symptoms," he said.

 

We had very good data from his hospitalizations, which was very reassuring, but to be complete and to be compulsive we wanted the Holter monitor.

 

"Quite frankly we've been considering doing a Holter monitor for the last few months. We've had the luxury of being able to monitor the vice president on two occasions while he's been in hospital for at least 72 hours, and on none of those occasions did he have any sort of sustained rhythm abnormality," Reiner said. "So we had very good data from his hospitalizations, which was very reassuring, but to be complete and to be compulsive we wanted the Holter monitor, and this is just when it came out on the schedule."

"What we have told the vice president a long time ago is that we would not discriminate against him, simply because he's Vice President of the United States," he added. "All of the care that the vice president has received while I've had the privilege to be his physician, has been generated by his clinical status, not by his office."

The full GWU press conference appears at CSPAN.org.

Issue of Cheney's fitness for office

Not surprisingly, major news outlets over the weekend made this their top story. Besides reporting the story, the New York Times also featured a News Analysis article by Dr Lawrence K Altman, raised again the lurking issue of what this disclosure means for Cheney's ability to do his job.

Vice President Cheney leaves the hospital after receiving an ICD (Source: George Washington University Hospital)

"The optimistic picture that Vice President Dick Cheney's doctors painted today after successfully implanting a pacemaker and defibrillator in his chest is based on a number of recent studies of similar cases, but is shadowed by the frequent cardiac related episodes that Mr Cheney has suffered in recent months," Altman wrote. These episodes - his heart attacks, angioplasty, stent placement for restenosis, followed by this need for an ICD - "raise questions about whether Mr Cheney's condition is deteriorating, and they are hard to answer."

Dr Douglas Zipes (University of Indiana, Indianapolis), president of the American College of Cardiology, told the Times that the doctors' optimism was "not unreasonable."

 

Cheney's coronary disease appears to be stable and under control, he's no evidence of heart failure, and any life-threatening arrhythmia is now adequately taken care of.

 

"The optimism should be based on Mr Cheney's present status, and that his coronary disease appears to be stable and under control, he's no evidence of heart failure, and any life-threatening arrhythmia is now adequately taken care of, " Zipes said. "What no one can predict is whether his coronary disease will stay stable."

Dr Eugene Braunwald (Partners Healthcare System, Boston, MA) is also quoted as saying that from his recent clinical events, "you get the picture of coronary artery disease that really is not quiescent, but that does not mean Mr Cheney's in mortal danger of something happening in the next few months."

The Times also noted that Cheney expects to fly to his home in Wyoming on Thursday, "where he often relaxes and goes on fly-fishing expeditions."

CNN reports that a spokeswoman for Cheney said that the vice president was "feeling great," after spending Sunday relaxing at home with his family.



Related links

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4. [Heartwire > Mediapulse; Jun 30, 2001]

5. [Heartwire > Mediapulse; Jun 29, 2001]


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