Sick sinus syndrome — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 66 of 2022

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting sick sinus syndrome or death from sick sinus syndrome with the circumstances of a person's relevant service:

1. (1)
   having atrial fibrillation or atrial flutter at the time of the clinical onset of sick sinus syndrome;
2. (2)
   having hypertension at the time of the clinical onset of sick sinus syndrome;
3. (3)
   having ischaemic heart disease at the time of the clinical onset of sick sinus syndrome;
4. (4)
   having heart failure at the time of the clinical onset of sick sinus syndrome;
5. (5)
   having rheumatic fever at the time of the clinical onset of sick sinus syndrome;
6. (6)
   having pericarditis at the time of the clinical onset of sick sinus syndrome;
7. (7)
   having cardiomyopathy at the time of the clinical onset of sick sinus syndrome;
8. (8)
   having non-infectious myocarditis at the time of the clinical onset of sick sinus syndrome;

   Note: Non-infectious myocarditis can be acute or chronic.

   Note: Non-infectious myocarditis can be of autoimmune, infiltrative or immunological origin. Examples of causes of non-infectious myocarditis include immune checkpoint inhibitor therapy and giant cell myocarditis.

9. (9)
   having viral myocarditis at the time of the clinical onset of sick sinus syndrome;

   Note: Viral myocarditis can be acute or chronic.

   Note: Examples of viral causes of myocarditis include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus, group B coxsackieviruses and dengue virus.

10. (10)
    having a non-viral infection of the myocardium at the time of the clinical onset of sick sinus syndrome; (a) Borrelia burgdorferi (Lyme disease); (b) Cysticercus species (cysticercosis); (c) Echinococcus species (hydatid disease); (d) Toxoplasma gondii (toxoplasmosis); and (e) Trypanosoma cruzi (Chagas disease);

    Note: A non-viral infection of the myocardium can be caused by bacteria, protozoa, fungi or parasites.

    Note: Examples of non-viral infections of the myocardium include:.

11. (11)
    having infiltration of the myocardium due to an infiltrative disease from the specified list of infiltrative diseases at the time of the clinical onset of sick sinus syndrome;

    Note: specified list of infiltrative diseases is defined in the Schedule 1 - Dictionary.

12. (12)
    having a benign or malignant neoplasm involving the sinoatrial node before the clinical onset of sick sinus syndrome;

    Note: A neoplasm involving the sinoatrial node can be primary or metastatic. An example of a primary neoplasm involving the sinoatrial node is cardiac lymphoma.

13. (13)
    having a non-neoplastic lesion which compresses the sinoatrial node at the time of the clinical onset of sick sinus syndrome;

    Note: Examples of non-neoplastic lesions which compress the sinoatrial node include cardiac tamponade and coronary artery aneurysm.

14. (14)
    having a thyroid condition from the specified list of thyroid conditions at the time of the clinical onset of sick sinus syndrome;

    Note: specified list of thyroid conditions is defined in the Schedule 1 - Dictionary.

15. (15)
    having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical onset of sick sinus syndrome;

    Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.

16. (16)
    having obstructive sleep apnoea at the time of the clinical onset of sick sinus syndrome;

    Note: obstructive sleep apnoea is defined in the Schedule 1 - Dictionary.

17. (17)
    having a mineral or electrolyte abnormality from the specified list of mineral or electrolyte abnormalities at the time of the clinical onset of sick sinus syndrome;

    Note: specified list of mineral or electrolyte abnormalities is defined in the Schedule 1 - Dictionary.

18. (18)
    having a thoracic surgical procedure or an invasive cardiac procedure within the 1 year before the clinical onset of sick sinus syndrome; (a) catheter ablation of arrhythmias; (b) open heart surgery; and (c) transcatheter aortic valve implantation;

    Note: Examples of thoracic surgical procedures include vascular, mediastinal, pulmonary and chest wall surgery.

    Note: Examples of invasive cardiac procedures include:.

19. (19)
    having a heart transplant before the clinical onset of sick sinus syndrome;
20. (20)
    having a surgical procedure involving general or regional anaesthesia within the 30 days before the clinical onset of sick sinus syndrome;
21. (21)
    having cardiac stereotactic ablative radiotherapy or cryotherapy within the 6 months before the clinical onset of sick sinus syndrome;
22. (22)
    experiencing penetrating trauma to the heart within the 3 months before the clinical onset of sick sinus syndrome;
23. (23)
    taking a drug from the specified list of drugs within the 30 days before the clinical onset of sick sinus syndrome;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

24. (24)
    undertaking strenuous physical activity greater than 6 METs: (a) for an average of at least 20 hours per week; and (b) for a continuous period of at least 5 years before the clinical onset of sick sinus syndrome; and if that strenuous physical activity has ceased before the clinical onset of sick sinus syndrome, then that onset occurred within 5 years of cessation;

    Note: MET is defined in the Schedule 1 - Dictionary.

25. (25)
    being envenomated by a snake belonging to the family Viperidae within the 48 hours before the clinical onset of sick sinus syndrome;
26. (26)
    having atrial fibrillation or atrial flutter at the time of the clinical worsening of sick sinus syndrome;
27. (27)
    having hypertension at the time of the clinical worsening of sick sinus syndrome;
28. (28)
    having ischaemic heart disease at the time of the clinical worsening of sick sinus syndrome;
29. (29)
    having heart failure at the time of the clinical worsening of sick sinus syndrome;
30. (30)
    having rheumatic fever at the time of the clinical worsening of sick sinus syndrome;
31. (31)
    having pericarditis at the time of the clinical worsening of sick sinus syndrome;
32. (32)
    having cardiomyopathy at the time of the clinical worsening of sick sinus syndrome;
33. (33)
    having non-infectious myocarditis at the time of the clinical worsening of sick sinus syndrome;

    Note: Non-infectious myocarditis can be acute or chronic.

    Note: Non-infectious myocarditis can be of autoimmune, infiltrative or immunological origin. Examples of causes of non-infectious myocarditis include immune checkpoint inhibitor therapy and giant cell myocarditis.

34. (34)
    having viral myocarditis at the time of the clinical worsening of sick sinus syndrome;

    Note: Viral myocarditis can be acute or chronic.

    Note: Examples of viral causes of myocarditis include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus, group B coxsackieviruses and dengue virus.

35. (35)
    having a non-viral infection of the myocardium at the time of the clinical worsening of sick sinus syndrome; (a) Borrelia burgdorferi (Lyme disease); (b) Cysticercus species (cysticercosis); (c) Echinococcus species (hydatid disease); (d) Toxoplasma gondii (toxoplasmosis); and (e) Trypanosoma cruzi (Chagas disease);

    Note: A non-viral infection of the myocardium can be caused by bacteria, protozoa, fungi or parasites.

    Note: Examples of non-viral infections of the myocardium include:.

36. (36)
    having infiltration of the myocardium due to an infiltrative disease from the specified list of infiltrative diseases at the time of the clinical worsening of sick sinus syndrome;

    Note: specified list of infiltrative diseases is defined in the Schedule 1 - Dictionary.

37. (37)
    having a benign or malignant neoplasm involving the sinoatrial node before the clinical worsening of sick sinus syndrome;

    Note: A neoplasm involving the sinoatrial node can be primary or metastatic. An example of a primary neoplasm involving the sinoatrial node is cardiac lymphoma.

38. (38)
    having a non-neoplastic lesion which compresses the sinoatrial node at the time of the clinical worsening of sick sinus syndrome;

    Note: Examples of non-neoplastic lesions which compress the sinoatrial node include cardiac tamponade and coronary artery aneurysm.

39. (39)
    having a thyroid condition from the specified list of thyroid conditions at the time of the clinical worsening of sick sinus syndrome;

    Note: specified list of thyroid conditions is defined in the Schedule 1 - Dictionary.

40. (40)
    having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical worsening of sick sinus syndrome;

    Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.

41. (41)
    having obstructive sleep apnoea at the time of the clinical worsening of sick sinus syndrome;

    Note: obstructive sleep apnoea is defined in the Schedule 1 - Dictionary.

42. (42)
    having a mineral or electrolyte abnormality from the specified list of mineral or electrolyte abnormalities at the time of the clinical worsening of sick sinus syndrome;

    Note: specified list of mineral or electrolyte abnormalities is defined in the Schedule 1 - Dictionary.

43. (43)
    having a thoracic surgical procedure or an invasive cardiac procedure within the 1 year before the clinical worsening of sick sinus syndrome; (a) catheter ablation of arrhythmias; (b) open heart surgery; and (c) transcatheter aortic valve implantation;

    Note: Examples of thoracic surgical procedures include vascular, mediastinal, pulmonary and chest wall surgery.

    Note: Examples of invasive cardiac procedures include:.

44. (44)
    having a heart transplant before the clinical worsening of sick sinus syndrome;
45. (45)
    having a surgical procedure involving general or regional anaesthesia within the 30 days before the clinical worsening of sick sinus syndrome;
46. (46)
    having cardiac stereotactic ablative radiotherapy or cryotherapy within the 6 months before the clinical worsening of sick sinus syndrome;
47. (47)
    experiencing penetrating trauma to the heart within the 3 months before the clinical worsening of sick sinus syndrome;
48. (48)
    taking a drug from the specified list of drugs within the 30 days before the clinical worsening of sick sinus syndrome;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

49. (49)
    being envenomated by a snake belonging to the family Viperidae within the 48 hours before the clinical worsening of sick sinus syndrome;
50. (50)
    inability to obtain appropriate clinical management for sick sinus syndrome;

Aggravation-only factors: the factors in subsections 9(26) to 9(50) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.