Since the first reports on computerized ECG analysis were published in the early 1960s, there have been major advancements in this technology that have led to the availability of a computer interpretation for nearly all ECGs processed in the United States. Misinterpretation of the ECG is still a problem, however, especially with rhythm diagnoses and correctly identifying pacemaker activity. A sound understanding of the strengths and limitations of the current computer analysis programs is essential to avoid over-reliance on computer analysis and to prevent the inappropriate management of patients. The reliability of computerized ECG analysis programs will only continue to improve, and the degree to which expert readers will continue to be needed remains to be seen. In the meantime, until there is true automated ECG analysis, computerized interpretations should be viewed as an adjunct to, not a substitute for, interpretation by a competent and experienced physician.