This brief review is aimed primarily as a resource for the clinician and summarizes recent advancements in electrocardiographic monitoring in the intensive care unit. Emphasis is placed on recent advances in ICU ECG and cardiac event monitoring with particular attention to arrhythmia detection in patients following myocardial infarction. Specific topics addressed include: clinical indicators of impending arrhythmic events and sudden death, signal averaged ECG, QT dispersion, ST segment fluctuation, T-wave alternans, QT interval beat-to-beat variability, heart rate variability, and advances in automated arrhythmia detection.