Catheters will be placed via vascular access into the heart, great vessels or pericardial space to ascertain the presence of an abnormal rhythm and its cause. If indicated, ablation therapy will be used to attempt to eliminate the abnormal rhythm.

I authorize and direct Brett Gidney, M.D., with associates or assistants of his or her choice, to perform the procedure of Electrophysiology Study/ Catheter Ablation on: