This paper presents an ECG compression algorithm based on wavelet transform and region of interest (ROI) coding. The algorithm has realized near-lossless coding in ROI and quality controllable lossy coding outside of ROI. After mean removal of the original signal, multi-layer orthogonal discrete wavelet transform is performed. Simultaneously,feature extraction is performed on the original signal to find the position of ROI. The coefficients related to the ROI are important coefficients and kept. Otherwise, the energy loss of the transform domain is calculated according to the goal PRDBE (Percentage Root-mean-square Difference with Baseline Eliminated), and then the threshold of the coefficients outside of ROI is determined according to the loss of energy. The important coefficients, which include the coefficients of ROI and the coefficients that are larger than the threshold outside of ROI, are put into a linear quantifier. The map, which records the positions of the important coefficients in the original wavelet coefficients vector, is compressed with a run-length encoder. Huffman coding has been applied to improve the compression ratio. ECG signals taken from the MIT/BIH arrhythmia database are tested, and satisfactory results in terms of clinical information preserving, quality and compress ratio are obtained.