Crossroads in electrocardiographic lead development: a roadmap to the future of electrocardiographic leads in clinical electrocardiography.

摘要

This issue of the Journal is devoted to the important topic of electrocardiographic (ECG) leads and comprises a compendium of articles assembled from presentations given at recent international symposia and workshops addressing important issues and concerns relating to lead systems, "reduced lead systems," their usage, and standardization. This accompanying editorial is meant to provide history, commentary, and hopefully direction for future development and resolution of some of these issues facing both the clinical and technical (vendor) electrocardiography communities.The ECG has long been recognized as one of the most successful and important tools in the rapid, noninvasive assessment of cardiac state and diagnosis of cardiac conditions. More often than not, the resting 12-lead ECG is and has been used to rule out cardiac conditions in the presence of conflicting or ambiguous clinical symptoms or signs. Does the patient have a regular heart rhythm? Are the wave intervals and morphologies normal? As clinical electrocardiography has evolved, detection and characterization of cardiac conditions have been refined to the point that ECG interpretation is used to quantify diagnoses: Where and how large is the infarct? Where is the ischemia origin? In which bundle or branch of the conduction system does conduction block occur? Where is the ectopic focus of a tachycardia? At the same time, clinical need and practice have pushed the application of the technology for use in exercise stress testing and ambulatory or ST monitoring, both of which led to the use of lead systems and reference electrode sites that differ from those of the standard 12-lead ECG for reasons of convenience, signal-to-noise considerations, or, early on, technical limitations. This clearly clouds the issue of reading and interpreting ECGs, hence the renewed interest in standardizing the technical aspects of recording ECGs.