WASHINGTON -- President Bush went back to work in the Oval Office yesterday morning after his irregular heartbeat returned to normal overnight in response to medication.
Although Mr. Bush's heart rhythm irregularity recurred briefly before his release at 9 a.m. from Bethesda Naval Hospital, his doctors determined it would not be necessary to apply the electrical shock treatment they were considering Sunday night.
"Back to work," the president declared when he arrived at the White House 20 minutes later, grinning broadly and flashing two thumbs up as a cheering crowd of staff members welcomed him home.
Mr. Bush did not experience a heart attack or any damage to the heart muscle, his doctors said. At 9:45 a.m. his heart again returned to its normal rhythm for the rest of the day, the White House said.
"Since he had such a nice response to the drugs, we decided that we would continue the drugs, monitor the doses and get the president out of the hospital," said the chief White House physician, Dr. Burton Lee.
The doctors insisted their decision was made without any political considerations, but it had the effect of rendering unnecessary the temporary assumption of power by Vice President Dan Quayle.
Mr. Quayle had been alerted late Sunday afternoon that he might have to take over the presidency for a few minutes while Mr. Bush was put under general anesthesia for an electrical shock procedure, which they were considering yesterday morning had the president not responded sufficiently to medication intended to control the irregular heartbeat.
The vice president was called at his home shortly after 6 a.m. yesterday, however, and advised by White House Chief of Staff John H. Sununu that his services as chief executive would not be required.
However, Mr. Bush, a highly athletic and competitive 66-year-old who until last weekend had not been in the hospital for 17 years, came back to the White House without his usual aura of indestructibility.
He pointed immediately to the most obvious symbol of his illness: a bandage covering his right forearm where a tube for injecting medicines was still inserted. It was removed later in the day.
Nurses also slipped into the Oval Office at odd moments throughout the day to update their readings on his heart rate, using a portable monitor set up in the president's adjacent study.
Dr. Lee also revealed that Mr. Bush had complained of feeling below par even before the incident Saturday afternoon, when he experienced shortness of breath while jogging.
"He has said to me in the last couple of weeks,'Gee-whiz, maybe I'm getting older,' " Dr. Lee said at a briefing following the president's release from the hospital yesterday. But at that time, which also followed a jogging outing, "there was nothing there," the doctor said.
As the president plowed yesterday through a typical Bush schedule of two meetings with foreign leaders, several photo sessions, staff briefings and a visit by helicopter to a charity reception in Potomac that was canceled at the last minute because of bad weather, he was relaxed and animated but clearly fatigued.
"I'm just glad to be here," Mr. Bush told reporters as he began an Oval Office session with former Soviet Foreign Minister Eduard A. Shevardnadze.
In fact, it was something of a surprise to see him after the somber White House announcement Sunday night that Mr. Bush had not yet regained a normal heart rate after more than 24 hours of treatment with the drugs digoxin and procainamide.
If the president's condition, known as atrial fibrillation, had not been corrected by the time he woke up yesterday morning, the doctors had planned to try to jolt his heart back to a normal rhythm with an electrical shock. That procedure, called electrical cardioversion, would have required Mr. Bush to undergo general anesthesia for up to 10 or 15 minutes, officials said.
Letters to House Speaker Thomas S. Foley, D-Wa., and Senate President pro tem Robert C. Byrd, D-W.Va., had already been prepared in case Mr. Bush had to formally turn over his power as president to Mr. Quayle in accordance with the provisions of the 25th Amendment.
But by the time the vice president arrived for work at his normal time of 7:45 a.m., reports were already airing on the television morning shows that his boss was headed back to business as usual.
Mr. Bush's heart rate, which had sped up to about one and a half times its normal rate Saturday afternoon, later returned to normal. The regular rhythm returned for the first time at 10:45 p.m. Sunday night and continued until 4:45 a.m., when the fibrillation began again, ending at 9:45 a.m. yesterday.
The president insists he wants to return to a fully normal schedule, including his rigorous exercise program. He said he agreed to abide by his doctor's advice to "kind of work back into it. But I think it's OK."