 Semiconductor quantum dots, QDs, have become increasingly popular for use in electrochemiluminescence, ECL. This is due to their high luminescence efficiency and signal modulation capability. Recently, researchers have developed an efficient ECL system with QDs as luminafores. This review provides a comprehensive summary of recent advances in ECL using QDs as luminafores. First, the luminescence process and ECL mechanism of QDs with different core reactants are discussed. Next, the influence of surface defects on ECL performance of QDs is highlighted. Furthermore, several typical ECL enhancement strategies are summarized. Additionally, the applications of QDs in ECL biosensing are overviewed, including immunoassays, nucleic acid analysis, and the detection of small molecules. Lastly, the challenges and prospects of QDs as ECL luminafores in biosensing are featured. This article was authored by Huishan, Pingzhou, and Binsu. We are article.tv, links in the description below.