CONSENTS

****DEVICE CONSENT*******
A total of > 45 minutes was spent directly with the patient in the office during
this visit.  More than half of the time during this visit was spent counseling
the patient, reviewing the pathophysiology with him, and explaining treatment
and options.  I drew pictures and diagrams to help illustrate their underlying
pathophysiology and gave it to the patient.  

Treatment options discussed include no therapy versus medical therapy versus
procedure.  The pros and cons of each approach were thoroughly discussed in
depth with the patient.  

The risks and benefits of the procedure were explained to the patient in full,
and in simple terms.  The risks of the procedure include, but are not limited
to: pain, bleeding, infection, pneumothorax, perforation of vessels or heart,
pericardial effusion, tamponade requiring intervention or surgery, unstable
heart rhythm, device malfunction or recall, stroke, myocardial infarction, and
death. The risks of blood transfusion were discussed, and include fever,
transfusion reaction, and infection. All questions were answered, and the
patient voices understanding.  The patient acknowledged the risks of the
procedure, and still wanted to proceed.   

Device decision was discussed with the patient and included patient’s health goals,

preferences and values related to this decision. The patient understands all the risks and

benefits of this decision. Patient agrees with the plan which is to:

• Implant an Subcutaneous ICD, Transvenous ICD, or CRT-D to prevent sudden cardiac death

• Not implant a device at this time to prevent sudden cardiac death

Link for Patient Hand out on Transvenous ICD vs Subcutaneous ICD 

*****AFLUTTER ABLATION CONSENT****
A total of > 45 minutes was spent directly with the patient in the office during
this visit.  More than half of the time during this visit was spent counseling
the patient, reviewing the pathophysiology of atrial flutter with him, and
explaining treatment and options.  I drew pictures and diagrams to help
illustrate their underlying pathophysiology and gave it to the patient.  

Treatment options discussed include no therapy versus medical therapy versus
procedure.  The pros and cons of each approach were thoroughly discussed in
depth with the patient.  

The risks and benefits of the procedure were explained to the patient in full,
and in simple terms.  The risks of the procedure include, but are not limited
to: pain, bleeding, infection, damage to dentition and/or oropharynx, esophageal
dissection, pneumothorax, perforation of vessels or heart, pericardial effusion,
tamponade requiring intervention or surgery, unstable heart rhythm, stroke,
myocardial infarction, and death. The risks of blood transfusion were discussed, and include fever, transfusion reaction, and infection. All questions were answered, and the patient voices understanding.  The patient acknowledged the risks of the procedure, and still wanted to proceed.   

****CONSENT - ABLATION (SVT, PVCs, Flutter)*******

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A total of > 45 minutes was spent directly with the patient in the office during
this visit.  More than half of the time during this visit was spent counseling
the patient, reviewing the pathophysiology of atrial fibrillation with him, and
explaining treatment and options.  I drew pictures and diagrams to help
illustrate their underlying pathophysiology and gave it to the patient.  

Treatment options discussed include no therapy versus medical therapy versus
procedure.  The pros and cons of each approach were thoroughly discussed in
depth with the patient.  

The risks and benefits of the procedure were explained to the patient in full,
and in simple terms.  The risks of the procedure include, but are not limited
to: pain, bleeding, infection, perforation of vessels or heart, pericardial effusion, tamponade requiring intervention or surgery, damage to existing native
conduction system requiring need for permanent pacemaker, unstable heart rhythm, stroke, myocardial infarction, and death. The risks of blood transfusion were discussed, and include fever, transfusion reaction, and infection. All questions were answered, and the patient voices understanding.  The patient acknowledged the risks of the procedure, and still wanted to proceed.   

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*****AFIB ABLATION CONSENT****
A total of > 45 minutes was spent directly with the patient in the office during
this visit.  More than half of the time during this visit was spent counseling
the patient, reviewing the pathophysiology of atrial fibrillation with him, and
explaining treatment and options.  I drew pictures and diagrams to help
illustrate their underlying pathophysiology and gave it to the patient.  

Treatment options discussed include no therapy versus medical therapy versus
procedure.  The pros and cons of each approach were thoroughly discussed in
depth with the patient.  

The risks and benefits of the procedure were explained to the patient in full,
and in simple terms.  The risks of the procedure include, but are not limited
to: pain, bleeding, infection, damage to dentition and/or oropharynx, esophageal
dissection, pneumothorax, perforation of vessels or heart, pericardial effusion,
tamponade requiring intervention or surgery, unstable heart rhythm, stroke,
pulmonary vein stenosis, myocardial infarction, and death. The risks of blood
transfusion were discussed, and include fever, transfusion reaction, and
infection. All questions were answered, and the patient voices understanding. 
The patient acknowledged the risks of the procedure, and still wanted to proceed.   

*******CATH CONSENT******
The risks and benefits of the procedure (coronary angiography possible PCI) were
explained to the patient in full, and in simple terms.  The risks of the
procedure include, but are not limited to: pain, bleeding, perforation of
vessels or heart, pericardial effusion, tamponade requiring intervention or
surgery, unstable heart rhythm, stroke, myocardial infarction, and
death. The risks of blood transfusion were discussed, and include fever,
transfusion reaction, and infection. All questions were answered, and the
patient voices understanding.  The patient and his family acknowledged the risks
of the procedure, and they all still wanted to proceed.