Heavy metal ions, especially Cd2+, As3+, Pb2+, and Hg2+, pose a huge threat to the environment and human health. Electrochemical sensors based on aptamers have emerged as a research hotspot in the field of heavy metal ion detection. This type of sensor has been widely applied in multiple fields such as molecular biology analysis, food inspection, and environmental chemical analysis due to the high specificity of its aptamer, the flexibility of electrochemical analysis, the simplicity of operation and the diversity of detection objects. Based on the signal source, the electrochemical aptasensors for heavy metal ions have been classified into unlabelled and labelled types. The unlabeled electrochemical aptasensors directly detect heavy metal ions through the electrochemical signal changes caused by the combination of the aptamer and the target heavy metal ions. However, their sensitivity and anti-interference ability are limited in complex samples. The labeled electrochemical aptasensors can improve the detection performance by incorporating labelled molecules such as redox molecules or nanomaterials, among which, nanoparticle labeled and graphene-labeled sensors have unique advantages in signal amplification and target molecule recognition. Currently, electrochemical aptasensors still face some challenges in the detection of heavy metal ions. For instance, the aptamer screening process, the stability and repeatability of the sensors all need to be further optimized, as well as the issue of matrix interference in actual sample detection. In the future, efforts should be further intensified in key directions such as material innovation, optimization of signal amplification mechanisms, construction of portable platforms, and expansion of practical applications, accelerating the transformation towards miniaturization, integration, and intelligence to meet the demands of on-site monitoring and personal health monitoring.