A vast number of publications have investigated the application of electrocoagulation (EC) process in heavy metal ions removal from wastewaters. Most of these studies were simple lab-scale using synthetic wastewater with the absence of holistic and systematic approach to consider the process complexity. This comprehensive review considers the fundamental aspects of EC processes such as mechanisms, kinetic models, and isotherm models used by different researchers. Furthermore, the impact of the main design and process operational parameters on the removal efficiency is discussed and analyzed. Many concluding remarks and perspectives are stated to give insights for possible future investigations.