The electrocardiogram (ECG) can be affected by intraindividual variations from various sources that may confuse the diagnosis of the underlying cardiac condition and impair the accuracy of ECG interpretation. Intraindividual variability is a hindrance in serial ECG analysis, where ECGs of the same individual, but taken at different times, are compared. Two sources of intraindividual variability can be distinguished as follows: variability related to the technical circumstances during ECG recording (technical sources) and nonpathologic biologic variability (biological sources). Among the technical sources, variation in electrode positioning between recordings is the most confusing. Of the biological sources, respiratory variations are effective at any time scale, but the most important are age and weight that work on prolonged time scales. Technical problems are best prevented by rigorously sticking to a standard acquisition protocol. Criteria can be adapted to changing circumstances (age, weight), and by computer modeling, it may be possible to correct the ECG diagnosis for some sources of intraindividual variability.