The ECW Heavyweight Championship was originally a National Wrestling Alliance title known as the Eastern Championship Wrestling (ECW) Heavyweight Championship. However, in 1994, the ECW Heavyweight Champion, Shane Douglas, was entered into a tournament for the NWA World Heavyweight Championship. On August 27, he defeated 2 Cold Scorpio in the tournament final to win the NWA World Heavyweight Championship, but immediately relinquished it and instead proclaimed himself the new ECW World Heavyweight Champion. Days later, Eastern Championship Wrestling left the National Wrestling Alliance as the name of the promotion was changed to Extreme Championship Wrestling, thus the title became known as the Extreme Championship Wrestling (ECW) World Heavyweight Championship. The title officially gained its "World" status on August 27, 1999 after years of being defended internationally against challengers from around the world and remained active until April 11, 2001 when World Wrestling Entertainment subsequently purchased the promotion after its closure.
The title was reactivated following WWE's decision to revive Extreme Championship Wrestling as a third brand. Prior to One Night Stand 2006, Paul Heyman stated that if Rob Van Dam was to win the WWE Championship at One Night Stand, the ECW World Heavyweight Championship would replace the WWE Championship. When Rob Van Dam went on to defeat John Cena for the WWE Championship at the event, the ECW World Heavyweight Championship was presented to Rob Van Dam by Paul Heyman during the premiere episode of the new ECW brand. However, Rob Van Dam stated that he would continue to use both titles and remain WWE Champion while being the new ECW World Heavyweight Champion.
Weeks later, the ECW World Heavyweight title belt was replaced with a new similar belt that features the new ECW logo and new plates. The title was then renamed the ECW World Championship around the start of The Big Show's reign to avoid confusion with the SmackDown! brand's World Heavyweight Championship. Around the time of John Morrison's reign, the title was simply referred to as the ECW Championship. The championship has yet to regain world title status from PWI.