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Vice President Cheney Back at Work

Over the weekend, Vice President Dick Cheney was briefly hospitalized at George Washington University Hospital in Washington, DC.

On Saturday, Cheney had a defibrillator implanted into his chest to regulate his heartbeat. He spent Sunday at home and is planning to go to work on Monday.

Cheney had the defibrillator put in after he had tests that showed he is likely to have dangerous rapid heart rhythms. The cardioverter defibrillator has a battery that can give a mild shock to the heart.

This is the third time that Cheney has been to the hospital for heart-related problems since last November. The 60-year-old vice president has had four heart attacks since 1978 and had quadruple bypass surgery in 1988.

Dr. Stuart Seides, a cardiologist in Washington, explains what a defibrillator is and how it works.

Interview with Dr. Stuart Seides, associate director of the cardiology department at Washington Hospital Center.

Vice President Cheney had an implantable cardioverter defibrillator (ICD) inserted into his chest on Saturday. What is it?

It's a device that is implantable and can detect abnormal heart rhythm and can respond to the abnormal rhythm by sending a shock to a person. It's exactly like what you see on TV when they bring out the paddles and shock someone. The difference is that this device is implanted.

Can you tell us how it works?

Electrodes are implanted in the heart and when a rhythm that is life-threatening is detected, it delivers a shock that will correct the rhythm and send it back to normal.

Vice President Cheney has described the ICD as a "pacemaker plus." What is the difference between a defibrillator and a pacemaker?

The pacemaker just sends out a low-energy regular current that speeds the heart rate up if it is too slow. A pacemaker is a much smaller and simpler device. It's not as sophisticated and doesn't shock the heart. A defibrillator is larger and more expensive. Most defibrillators, like the one Cheney has, have pacemaker capabilities. The two devices are different because the defibrillator is more sophisticated and it's newer to the medical scene.

Is the procedure to insert an ICD as routine as Cheney's doctors are making it sound?

It's becoming more routine because defibrillators are about the same size as pacemakers. What's really changed is the electrical circuitry, which is more complex in the defibrillator. Cheney appears to be at high risk and that's why a defibrillator was used instead of a pacemaker.

How often are defibrillators used on people with heart problems?

More and more. They are increasing in frequency because in the last few years, we have developed data that suggests using a defibrillator is a good idea for a person who is at high risk. It's used as a safety net. It might monitor the heart but never go off.

Will the ICD help extend Dick Cheney's life?

If he has an episode of rrhythmia it will.

Can a person with a defibrillator function normally and live an active and healthy lifestyle?

Yes, without a doubt. I wouldn't look at this as a setback. This doesn't mean that Cheney is sicker. It shouldn't affect him in anyway. I don't think his job will affect his illness at all.

Is the ICD available and affordable only to people that have a lot of money or the very best health insurance?

Yes, it's available, and they cost $20,000 to $25,000. They are very expensive. That's just for the device alone. It cost more with the pre-tests, the implantation, and the follow-up. It is an expensive procedure. This is new and useful. Insurance companies don't really like them and it's important to note that this is why insurance costs are rising.

Arrhythmia is one of the side effects of having heart disease. Are there any possible side effects from implanting this ICD?

Most ill effects occur at the time of implantation. Oncit's implanted, there are very few side effects. There is no risk of rejection or anything like that. There is a slight chance of infection or malfunction of the device since it is battery driven.

If the defibrillator kicks into action, will Vice President Cheney be able to feel it?

Patients have described it as being kicked in the chest. It is not a pleasant experience when it occurs. Some people start to lose consciousness when they have an abnormal heartbeat. If the defibrillator starts to work he will definitely be able to feel it.

I've read that doctors have advised Vice President Cheney to use a cell phone on his right side since the defibrillator was installed on his left side. Why?

There is a possibility of electrical interference. But that is very unlikely to happen. There are some issues about electrical interference and that it might trick the defibrillator. It's very doubtful that something like this would happen since the ICD is shielded, and there are very few things that could trick them.
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