Closing remarks: Leads symposium.

Electrocardiographic (ECG) lead systems have been evolving for as long as the ECG itself has been recognized as a measurable quantity. And although more than a century has elapsed since the first ECG lead system was proposed, many questions remain unanswered. Several recent initiatives reflect current areas of interest in ECG leads. These have included a Leads Summit organized under the auspices of the International Society for Computerized Electrocardiology (ISCE) and a special session at Computers in Cardiology 2007, both of which were held in Durham, NC, in the fall of 2007, and the GLIDER symposium, which took place in the Netherlands in December 2007. This issue of the Journal of Electrocardiology has also been devoted to this topic. Articles have covered issues including evaluation of limited 12-lead systems, exploration of additional information in the form of additional leads and alternative methods for display, and solutions to the proximal vs standard extremity electrode position problem. Presented as a well-balanced combination of reviewand researchstyled articles, the articles in this issue represent contributions from academia, industry, and users, which make up the 3 sides of the ISCE triangle. This contribution from all 3 stakeholders is important in going forward with practical solutions to the various issues. Firstly, academia must provide the theoretical research that underpins any solution. Users must be comfortable with whatever is presented. And finally, industry must provide commercial solutions that are flexible and transparent to allow further development. In going forward, we see several particular issues that will advance the state of the art in “leads” research. The following points may address some ideas that could materialize in the coming years.