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CNN Live Event/Special

Cheney Receives ICD, Excellent Prognosis

Aired June 30, 2001 - 11:54   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
BRIAN NELSON, CNN ANCHOR: Hello, I'm Brian Nelson at the CNN Center in Atlanta.

Doctors who performed an operation this morning on Vice President Dick Cheney are holding a news conference at this hour. We'd like to join that live. Let's listen in.

(JOINED IN PROGRESS)

DR. ALAN WASSERMAN, GEORGE WASHINGTON UNIVERSITY HOSPITAL: Everything went exceedingly well, exactly as planned.

The first part of the study was the electrophysiology study which was performed, which revealed an arrhythmia that was easily terminated with one pace feed. Because of the arrhythmia, which was a ventricular tachycardia that was inducible, we then went on and implanted the defibrillator or, as has been called, the pacemaker plus. Both procedures went extremely smooth and extremely easy and took a very short amount of time.

I have with me today Dr. Jonathan Reiner, who is the director of the Cardiac Catheterization Laboratory at George Washington University and the vice president's personal cardiologist, on my right. And on my left is Dr. Sung Lee, the director of the Electrophysiology Laboratory at George Washington University, who performed the procedure.

We would be happy now to take any and all questions.

Yes, sir?

QUESTION: You did induce a sustained irregular heartbeat and what did you do about it?

DR. JONATHAN REINER, GEORGE WASHINGTON UNIVERSITY HOSPITAL: In the Electrophysiology Laboratory, a very short but fast-run of the kind of tachycardia fast heartbeats that we were looking for was able to be induced. Dr. Lee terminated it very, very rapidly with just the insertion of a pacemaker beat. But the presence of that kind of inducibility of that type of fast heartbeat really made the treatment rather straightforward. And then Dr. Lee went ahead and implanted the ICD, or implantable cardioverter defibrillator, which went exceedingly smoothly.

QUESTION: What brand of defibrillator was that?

DR. SUNG LEE, GEORGE WASHINGTON UNIVERSITY HOSPITAL: The brand we put in was Medtronic GEM III DR.

WASSERMAN: Next question?

QUESTION: Basically, now that you've explained it in medical terms, can both you and Dr. Reiner explain want it means when he's tested, when were the tests and when the heart responded and just try to explain it in terms so that the average person will know exactly what...

WASSERMAN: I will let Dr. Reiner explain it in average terms.

REINER: Sure. Really, the test is designed to really asses whether a patient has a risk of developing a fast heart beat spontaneously. Now the problem with fast heartbeats is that the faster the heart beats, often the lower the blood pressure can go.

So some of them can be, you know, quite troubling to a patient if they occur spontaneously. So the electrophysiology test is designed to see if the heart muscle is vulnerable to produce these abnormally fast heartbeats. And there are some technical ways in which that is done.

And 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. Really the straightforward treatment option.

The outcomes really are terrific following the placement of that.

QUESTION: (OFF-MIKE) What do you anticipate is Cheney's prognosis?

REINER: Oh, I think it's terrific. The short term is straightforward. He's going to leave the hospital later on this afternoon and take it easy for the rest of today, and he'll be back at work on Monday morning, really in an unrestricted fashion.

QUESTION: Bypasses typically last 10 to 12 years. His last bypass -- he had a quadruple bypass in 1988. Does this mean that he may need another bypass soon? And what is his ejection fraction? If you could answer both of those questions.

WASSERMAN: Well, again, today's procedure was in no way related to his coronary disease. But I'll let Dr. Reiner answer those questions.

REINER: This is really sort of a separate issue. What we know is that, you know, patients who have had any damage to the heart muscle as a consequence of coronary artery disease may be prone to developing these rhythm problems, which is why we look for it. But this is not sort of a direct extension of bypass surgery by any means.

In answer to your second question, his ejection fraction is approximately 40 percent.

QUESTION: (OFF-MIKE) And how is that rate? As a doctor, is that serious? What does that say to you?

REINER: I would classify that fact to be moderate impairment.

QUESTION: Doctors, can you tell us two things, please. When was the vice president's first holter monitor test? And why was there such a long period of time between that test and this one?

REINER: Sure. The vice president had a holter monitor performed in 1988, so 13 years ago. That test showed none of the kind of rhythm problems that we found two weeks ago.

What we've learned in the last couple years, really the last year to year and a half, from large-scale trials, which have evaluated patients such as the vice president, we've learned how and, really, the value of evaluating patients who don't have symptoms. The first part of the 1990s taught us how to deal with rhythm problems in patients who had symptoms. Really the last couple of years have taught us how to evaluate -- triage, so to speak -- patients who don't have any symptoms, like the vice president.

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 was in the hospital for a total of at least 72 hours.

And on none of those occasions did he have any kind of sustained rhythm abnormality.

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.

WASSERMAN: Yes, ma'am?

QUESTION: Dr. Wasserman, could you speak a little bit more about the Medtronic device? And does it specifically just decelerate an accelerating heartbeat, or does it have a dual function?

WASSERMAN: Let me ask Dr. Lee to answer that question, OK?

LEE: The current generation of defibrillators actually has both a pacemaker and defibrillator in it. So if the vice president's heart rate slows down too much, well, the pacemaker part will kick in so that it will support his heart rate. If the vice president develops fast heart rhythms, the defibrillator part will be able to take care of that.

QUESTION: But you didn't find any slow heart beat today?

LEE: No.

WASSERMAN: But it has the added luxury, the device, of being a pacemaker. And that's why I think people have been referring to it as a pacemaker plus.

Yes, sir?

QUESTION: Given the vice president's history of coronary disease and taking into account his latest episode that brought him in here today, can you give us a sort of heart picture of him? What is his overall coronary condition?

WASSERMAN: There was no episode that brought him in here today. But Dr. Reiner can talk about his prognosis.

REINER: I think his overall condition has been remarkably stable, really, very stable now for a couple of decades. Remind you, you know, the vice president has had coronary disease since his 30s, and he has done and continues to do very well.

You know, this test today was really the outcome of pro-active testing on our part. It comes about from the understanding of how we can assess a patient's risk of developing one of these arrhythmias as we go forward; and now, taking a proactive step to look for the risk, not waiting for symptoms, looking for the risk.

So I say the vice president's prognosis is terrific. This device is going to be invisible to him. It, in many ways -- and I know this phrase has been put out in the media -- this really is an insurance policy for him. It's very, very likely that he will never use this device. And that is an absolute, terrific outcome.

QUESTION: How stable is it, though, that he's been here three times in less than a year for different heart-related reasons?

REINER: I really wouldn't attach any significance to that.

I mean, I think each of these hospitalizations has been extraordinarily brief. He's been back to work immediately. He functions on a completely asymptomatic, high level; exercises four times a week for a prolonged period of time.

So I really wouldn't put, you know, much stake in the number of admissions to the hospital. I think really I'd rather focus on how he is able to perform, and that's quite clearly on an extremely high level.

QUESTION: Just one more here, if I could, just so we can have what you might call a baseline. Just for our knowledge, how much guidance did his staff or his family give you on what you can tell us and how much you could tell us about his condition?

WASSERMAN: None.

QUESTION: Could you talk about the procedure this morning, exactly when you began, how long he was under, when he came up...

WASSERMAN: Sure.

QUESTION: ... all the details? WASSERMAN: Let me just start, and then I'll turn it over.

The procedure started at approximately 8:30 this morning. He was never really under. He was sedated and actually sleeping for much of the procedure. The electrophysiology study took about 35 minutes, and then Dr. Lee proceeded to move ahead with the implantation, which took about another hour, all told.

QUESTION: And he wasn't under for any of that time?

WASSERMAN: He was sedated for that time. He was sleeping for most of that time.

REINER: He was arousable but, you know, deeply sedated.

QUESTION: And he was on stomach or...

REINER: Lying on his back on a table, you know, on his back, comfortably, just essentially sort of snoozing for about an hour and a half.

WASSERMAN: The procedure is done in the cardiac catherization (ph) laboratory.

QUESTION: OK. And at what point did he awake, and what is his condition right now?

REINER: Immediately at the end of the procedure, the vice president opened his eyes. We spoke to him, and he wanted to know what time it was. We told what time it was. And he's continued to do very well.

WASSERMAN: He's in the recovery room now, fully awake and speaking. We understand that the president has just called in to talk to the vice president.

QUESTION: Following up on that, is there anything else he said about how he felt it went? Any other conversation you might have had (OFF-MIKE)? And then secondly, if Dick Cheney weren't vice president, would you have done any of these things you've done in the last week?

REINER: Let me answer the second question first, and then you can remind me of the first question.

After the -- the answer to the second question is absolutely. You know, 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.

And the care he received today is the care that any patient with his history should receive. And simply because he's vice president of the United States, we were not will to give him care that would have been substandard.

What was your first question?

QUESTION: Well, I mean, substandard, or extra care?

REINER: No, no. The point that I'm trying to get at is, the management of this problem and the evaluation of this problem is not esoteric. It's appropriate to look for this and to assess a patient's risk of developing arrhythmia, and then, finding that, proceeding to do an electrophysiology study. And, if positive, implanting a device like this is standard.

You know, there are thousands of these device implanted every year. And more we learn about how to treat these patients, the more patients are being treated in a proactive way, not in response to a problem but before a problem develops.

QUESTION: Your proaction is not related to him being vice president? You would do this even if he weren't vice president?

REINER: Absolutely, and I want to just go back and stress that point. All of the care that the vice president has received, while I have been privileged to be his physician, has been generated by his clinical status not by his office.

QUESTION: The first question was more about what he said, what he shared with you guys about how he felt it went. Were there any nerves going into it, anything that would share his own feelings about this?

REINER: He felt great when it was over. You know, the vice president didn't appear to be particularly nervous going into procedure. We presented the data to him. He understood the reason for doing it. And having done that, he was, you know, he was happy to do the procedure. You know, quite frankly, I think he was happier to do this than to get some planned dental work.

(LAUGHTER)

REINER: I think he appropriately chose the less onerous procedure.

QUESTION: But he just said (OFF-MIKE)?

REINER: Well, we were done. You know, he felt well. And, you know, we told him all of what transpired while he was sleeping. And he was pleased that it was over.

WASSERMAN: We were.

QUESTION: I understand the ICD is very sensitive to magnets. And I just wonder if that was the actual case of the ICD that was implanted into him today, and what that might mean for all of the security measures that are at the White House, in terms of magnetometers and other magnets that might be present.

WASSERMAN: I'll ask Dr. Lee to answer that question for you.

LEE: The ICD is actually very well shielded. Although, the magnet can interfere with the defibrillator function, it has to be very, very strong magnet, number one. The most magnets you will encounter, including the magnets that you will see with the metal detectors, it will not interfere with the defibrillator. Actually, if the vice president walks through the metal detector, it may set off the metal detector. But other than that, it should not affect the ICD.

QUESTION: Could it become a security risk if someone were wearing a strong magnet nearby the vice president?

WASSERMAN: There are certain precautions that any one with this needs. They're well-known.

Dr. Reiner, do you wants to elaborate?

REINER: Yes. It turns out that in reality, in day-to-day life, patients with this device really face essentially no restrictions and, really, essentially no environmental hazards.

Patients with these device can use cell phones. That's not really issue. They can go through airport security, as Dr. Lee said. The only issue is that these devices sometimes set off airport security, although I don't think that's will issue for next several years with the vice president.

(LAUGHTER)

REINER: But in terms of day-to-day life and day-to-day activities, this really will be transparent and, really, invisible to the vice president.

WASSERMAN: Yes, ma'am?

QUESTION: Thank you, Dr. Wasserman. Either you or Dr. Reiner, what is vice president's cholesterol level, and what is his blood pressure level?

WASSERMAN: His blood pressure is actually normal. I don't have his vital signs sheet today, but I will leave it as normal. His blood pressure is normal. And his cholesterol is terrific. He's, I believe, on pre-op bloods that were obtained on Thursday. In fact his LDL is as low as I have seen it, which, I believe, was 72, which is tremendous. So those parameters really have been very, very stable. In fact, the cholesterol has really improved.

QUESTION: One of the things that came up after we were last here in March by the Doctor Lawrence Alban (ph) was that he did not release the critical details about what the vice president's ejection fraction was. Could you speak about that that?

WASSERMAN: I think you just heard Dr. Reiner reiterate what he said it was and what he also said it was back in March. I am not sure what more you could say about that.

QUESTION: Can I ask you, what he is doing now, and what are his plans before he departs?

QUESTION: Do you know if he has any visitors? What's his schedule? Take us until he leaves the hospital.

WASSERMAN: He was eating lunch when we left, and, as I said, I think the president was calling in. He will be here for, Dr. Lee, what do you think? Another few hours?

LEE: Another few hours.

WASSERMAN: And then he'll be home.

Jon, what happens after that?

REINER: Well, for the rest of the day, as you've heard, he is going to basically just, you know, rest for few hours here. He will be sitting in a chair for perhaps an hour before he goes home. We'll walk around a little bit, and then he'll be discharged in the mid to late part of the afternoon. He'll take it easy tonight. There are no really extreme precautions. And back to work in an unrestricted fashion on Monday.

QUESTION: Does he ever worry about the upper chest? There was sort of a concern that he may at least have to take it easy there for few days or a few weeks.

REINER: Yes, I think that's appropriate. I'll Dr. Lee amplify on this.

We want the incision to heal. We want the device to sort of settle in place. And, you know, for next several days, certainly, and maybe next couple of weeks, we would advise against vigorous upper- body exercise, although we are going to encourage him to resume his usual aerobic exercise essentially immediately. But after that, you know, relatively short period of just letting the pocket heal, really back to a fairly unrestricted lifestyle.

QUESTION: Can we go back to the cell phone for a second? I think the American Heart Association website suggests there are newer cell phones that emit different frequencies than some of the older ones. (OFF-MIKE) Has that become an issue at all?

LEE: The cell phones -- again, the current generation of ICDs are very well shielded. And the cell phones may interact with the defibrillator, but it needs to be right on top of the defibrillator. And, you know, actually, it may cause -- it is not anything significant.

So, actually, currently recommendations are that you can use the cell phone, and the recommendation is that they use it on the right side, the side opposite to the implanted device.

QUESTION: Can you show us on yourself exactly where the device was implanted?

LEE: The device will be...

WASSERMAN: Hey, Sung, why don't you show them the device?

LEE: This is the size of the device. And it went right under...

WASSERMAN: Hold it up.

LEE: It went right under the skin right here.

WASSERMAN: On the left side.

LEE: On the left side.

(CROSSTALK)

WASSERMAN: Excuse me, the question was?

QUESTION: Follow-up care, please?

WASSERMAN: There were two questions. One was how many stitches, and follow-up care.

Sung, how many stitches?

LEE: It was two continuous stitches.

WASSERMAN: And follow-up care?

REINER: The follow-up care is going to be rather routine. You know, as after any invasive or surgical procedure, we like to check the wound, so the wound will be checked some time in the next few days, which is standard.

And, really, that's about it. These device need very little maintenance. A couple of times a year, Dr. Lee will use a computer to interrogate the device, basically to evaluate its function and its status. But really, it really requires no maintenance.

QUESTION: Will the device tell you if he had any arrhythmias?

WASSERMAN: Absolutely. One of the amazing things about this little device, which weighs about 80 grams -- and it's really no bigger than a pager -- is that it has the ability to really analyze and monitor every single heartbeat that the patient has. And any rhythm that it encounters, any rhythm abnormality that it encounters, it remembers in the computer memory.

So, it gives electrophysiologists like Dr. Lee the ability to get into the device electronically, so to speak, and to understand what it is seeing and what it is doing in an incredibly sophisticated manner.

Yes, ma'am?

QUESTION: Now, is this (OFF-MIKE) arrhythmia and electric impulse the same (OFF-MIKE). Will the vice president be able to feel that?

WASSERMAN: He should feel it; he will feel it. And, you know, many patients feel sort of a pop.

QUESTION: Like a pinch?

WASSERMAN: Like a pop.

REINER: Not a pinch.

WASSERMAN: Not a pinch, a pop.

(LAUGHTER)

WASSERMAN: No, but he will feel it, sure. It is really much less dramatic than in the movies. You know his hair is not going to stand on end. He will feel little pop in his chest.

QUESTION: Doctor, you mentioned to check the wound in a few days. Would that be done here, or would that be done at the White House?

REINER: Whatever is more convenient for the vice president.

WASSERMAN: Yes, sir?

QUESTION: Dr. Reiner, what have you told the vice president about his ability to be vice president, to remain vice president? How have the discussions gone on that and concerns that you have?

REINER: Well, in general I don't like to characterize conversations that I have had with the vice president. But what I will say is that I have explicitly told vice president that this procedure and this device would not in any way interfere with his ability to perform as vice president of the United States in his current, you know, full capacity and full schedule. I was explicit about that.

QUESTION: What about his overall heart condition, however, and general overall picture of Cheney performing as vice president for the next four years?

REINER: You know, think it of this way: This device really is insurance policy. And I think, as we move forward, you know, I have every expectations that he will continue to function in the capacity he has now.

I would be first to tell the vice president if I thought otherwise. And I don't anticipate this creating any problems as we move forward.

If anything, in the unlikely event that he has problem, this will go a long way to preventing one.

QUESTION: A few questions about the electrophysiology test. Were you able to provoke tachycardia with the very first test that you conducted, or did you have to conduct a number of them? During the test, how fast was his heartbeat? How long did you let that heartbeat raise?

NELSON: You have been listening to Dr. Jonathan Reiner and other doctors at George Washington University Hospital who conducted a small medical procedure on Vice President Cheney this morning.

And they have delivered a glowing report on the results of that. They said everything went extremely well, just as planned. In fact, what they did, they had a conducted a test with the catheter on the vice president to determine if they could induce a fast heartbeat.

And when they could, they then implanted a defibrillator, that is a sort of a pacemaker-plus, as the vice president calls it. If he has a slow heartbeat, it speeds it up. If he has a fast, irregular heartbeat, it slows it down and controls it.

And so the doctors say went extremely well. The vice president is still in the hospital. He will be recovering a little for a little time this afternoon before being discharged later this afternoon.

And for more now, let's go to CNN White House correspondent Kelly Wallace who's standing by the phone -- Kelly.

KELLY WALLACE, CNN WHITE HOUSE CORRESPONDENT: Well, Brian, yes I've been listening to that news conference with you all. We have learned that President Bush telephoned the vice president now about 15 minutes ago. The two men said they looked forward to seeing each other back at the office on Monday. They also talked about the president's meeting at Camp David with Japanese Prime Minister Koizumi.

Now actual news that the vice president had a device implanted in his body to correct any irregular heart rhythm first came from the president himself. He appeared with the Japanese leader, talking with reporters during his meetings with the Japanese prime minister. And one reporter asked the President if his vice president, his No. 2 and top adviser should go ahead and scale back his duties a bit. Here's what president had to say.

(BEGIN VIDEO CLIP)

GEORGE W. BUSH, PRESIDENT OF THE UNITED STATES: No, I don't think he ought to slow down. I think he ought to listen to his body. And I think he ought to -- which he has been doing. And I think he ought to work at a pace that he is comfortable with.

And I know Dick Cheney well. And if I were to say, you've got to slow down Mr. Vice President, he's going to say forget it because he's got a job to do; and he's a valuable member of my administration. He and his doctors made the right decision. And I am told that he's going to be back to work Monday morning and I look forward to seeing him in the Oval Office Monday morning. But I'm going to speak to him directly.

(END VIDEO CLIP)

WALLACE: And, again, that coming from the president before he made a phone call to his vice president. Again, the two leaders saying they look forward to seeing each other back at the office on Monday. Brian, the vice president did inform the president about his doctor's recommendations to pursue test and a possible procedure to have such a device implanted in his body on Tuesday. White House aides say the president fully encouraged the vice president to go forward with his doctor's recommendations. And clearly, you're hearing from the president as well as from the doctors at the hospital that the vice president in no way should be impaired, and should be able to keep up his duties as one of the top advisers to the president.

As you know, Brian, he has -- the vice president has quite a role in this administration. He led the president's task force, crafting the energy legislation that the president is pursuing. He's leading other task forces on global warming and domestic terrorism. He is a key contact when it comes to Capitol Hill, and he also plays a big role on international issues.

So the word from the President and the Vice President's doctors is that Mr. Cheney should be back at work on Monday and should be able to resume his normal duties -- Brian.

NELSON: All right, thank you, CNN's Kelly Wallace reporting from Camp David.

And once again, just to recap, that the operation performed on the vice president today went extremely well. The vice president right now is fully awake in his hospital bed. I think he has taken lunch already, so he is eating. And he expects to be discharged a little later this afternoon.

With me now is Dr. David Delurgio, a cardiologist from Emory University.

And he joins us here to -- give us some sense of your understanding of this operation and the doctor's prognosis for the vice president?

DR. DAVID DELURGIO, CARDIOLOGIST: Well, I'm very gratified to hear the level of care the vice president has received. This type of operation is now considered routine. As a matter of fact last year approximately 60,000 devices were implanted in the United States alone.

The operation takes approximately an hour, implanting a small device under the skin or muscle in the upper left chest usually. And wires are attached which pass through the veins down to the heart. The device is then tested under a worst-case scenario to make sure that it works well.

In his case, I expect him to do very well. He falls into the category of a prophylactic defibrillator. Large studies now have confirmed that we can predict that certain people are at increased risk of sudden cardiac death. And if those patients do receive a defibrillator, their risk of death can markedly decreased.

NELSON: So that was the importance of doing that test this morning before implanting the device, right?

DELURGIO: Yes, sir. We like to perform this test whenever we detect a high-risk profile patient. If the test is entirely normal, we may consider continuing to monitor that patient and treat them medically. We may reevaluate them with the monitor, for example, in another six months to 12 months to see if any arrhythmias are cropping up. Repeat electrophysiologic study is sometimes considered.

When the test is abnormal, however, that defines a high-risk group. At that point, we like to implant the defibrillator. And the studies have shown risk of cardiac death can be greatly reduced more than 33 percent in that type of patient.

NELSON: Now, the device that you have here is about same size as the one vice president received. It goes up here. Will vice president feel it as he moves about during his day?

DELURGIO: Well, people become used to the presence of the device quite quickly. It'll be implanted under the skin, as was described, and they'll be a small scar where incision was originally made.

As the device heals and a pocket forms around it, it will become evident that there is something there if you look closely, a small lump in shape of the device. And also the patient can feel it. It's mobile and loose and it moves with the patient. So that once it's healed in, they can do normal activities such as playing sports and general activities without any discomfort.

NELSON: There -- will there be any environmental hazard, as we listened to the news conference? Does this set off alarms at an airport?

DELURGIO: Well, it is made of metal.

NELSON: And will it be effected by an alarm?

DELURGIO: Yes and no. It is made of metal, so it could be detected in airport security situations as a metal device. Typically our patients show their identification card, then they're patted down, and perhaps wand searched. Environmental interactions are rare, but clearly described.

For example, some of our patients work in industry such as arc welding and other things. And some of those activities cannot be performed. But on a day-to-basis, use of cordless phones and cell phones can be easily performed. A cell phone should be used on the opposite side, keeping the antenna approximately six inches away from the device.

Other day-to-day activities in appliances are not an issue, including microwaves. Many people are under the false impression that microwaves are dangerous to these. Current microwaves do not emit much microwave energy and current devices are shielded against those frequencies.

NELSON: I understand thousands of Americans have a device like this. You, yourself, have performed this operation many times, right?

DELURGIO: That's correct. The use of ICDs is on the rise -- sharply on the rise. And the reason is that this device really is a lifesaver for many patients. Currently, despite the use of these devices, 300,000 people will drop dead suddenly in the United States every year. What we are trying to do is identify as many people as possible, hopefully in advance, to prevent the risk of a first event and implant these devices.

NELSON: The other question I have for you, I've been reading about how this will actually affect the vice president physically when it is in fact in use. Now suppose there is an irregular heartbeat, what is the impact to the vice president though? What does he feel? I've heard everything from a small burp to being kicked in the chest by a mule. And that's a wide variation.

DELURGIO: That's quite a difference, yes. Well, as you know, the device has multiple functions. We've been told that there's a pacemaker function. The pacemaker is, of course, undetectable to the patient.

Beyond that, when the rapid irregular heart rhythms occur, the device will approach them based on their rate. A relatively slow, but dangerous rhythm, may be terminated without pain; a very rapid rhythm approximating a cardiac arrest, will immediately be shocked with a high-energy shock, which is very evident to the patient when it occurs. And I daresay that most people, even though it is uncomfortable when it discharges, they are quite happy that their life has been saved.

NELSON: Does it hurt?

DELURGIO: It could cause some discomfort, yes.

NELSON: Discomfort -- does not hurt, OK. And now what do you think is the prognosis for the vice president with this device?

DELURGIO: Well, as we know, this device can reduce his risk of a sudden cardiac arrest quite dramatically. So we feel that his risk of a cardiac arrest with this device in place is very, very low. He, of course, has a heart problem, which he has continued to deal with.

NELSON: Which is a separate issue, this is heart disease.

DELURGIO: They're separate and related.

NELSON: Yes.

DELURGIO: His current problem is a result of his prior heart attacks. He continues to receive excellent care. The fact his heart has an ejection fraction of 40 percent, which is moderately reduced, does increase his overall mortality looking forward over the years. However, I believe that on appropriate care, he can expect a good long term outcome.

NELSON: Dr. David Delurgio from Emory University here in Atlanta. Thank you for taking the time to explain it to us.

DELURGIO: It's my pleasure.

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