Brugada syndrome is an inherited cardiac condition with the potential for development of life-threatening arrhythmias in relatively young individuals without significant structural cardiac abnormalities. The condition is characterized by a distinct coved-type ST segment elevation in the right precordial leads (V1-V3). This hallmark pattern (type 1) is often dynamic and sometimes concealed, and may be unmasked in certain conditions or under the effect of certain agents, which include variation of sympathovagal balance, hormones, metabolic factors and drugs. These factors may not only modulate electrocardiographic morphology and induce the characteristic type 1 pattern, but also predispose to ventricular arrhythmias. The risk of malignant arrhythmias in acute events with induced type 1 pattern may be imminent, particularly if the patient in fact has Brugada syndrome. The physician should be aware of the modulating factors that may underlie a Brugada pattern, and be able to recognize, identify and promptly correct them. The mechanisms responsible for the type 1 pattern and possible associated ventricular arrhythmias induced by these modulating factors have attracted growing attention and interest. Furthermore, not all induced Brugada ECG patterns are observed in patients with Brugada syndrome, existing the possibility for acquired Brugada patterns/syndrome and Brugada phenocopies. This paper reviews the modulating factors associated with induced type 1 pattern as possible causes of arrhythmogenesis, particularly in Brugada syndrome patients, describes some of the probable underlying mechanisms, and discusses the concepts of acquired Brugada syndrome and Brugada phenocopies.

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Introduction: Evaluating the impact of surgical treatment on health-related quality of life of breast cancer patients has become increasingly relevant, particularly for reconstructive procedures. The BREAST-Q consists of a broadly used patient-reported outcome measure to assess the impact of breast surgery on the health-related quality of life of these patients. The aim of this study was to translate and linguistically validate the BREAST-Q reconstructive module to European Portuguese.Material and Methods: The translation and linguistic validation process was based on the International Society for Pharmacoeconomics and Outcomes Research guidelines and started after obtaining permission from the original authors (developers). It involved two direct English to European Portuguese translations and a back translation, maintaining conceptual and cultural equivalence, an expert panel discussion, cognitive interviews with five patients and a final consensus.Results: The forward translations led to the revision of three conceptually distinct items. The backward translation resulted in predominantly wording discrepancies and the three conceptual disparities noted in the back translation were revised on a consensual version. All material was openly discussed with the original authors and in an expert panel meeting. One item was changed after the cognitive interviews. The final consensual version was obtained.Conclusion: This stepwise approach allowed to linguistically validate the BREAST-Q reconstructive module to European Portuguese so that it can be used in the Portuguese population. Additionally, the applied methodology may serve to support and guide other instruments for linguistic validation.