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The physics model of electron cyclotron heating (ECH) and current drive (ECCD) is becoming well validated through systematic comparisons of theory and experiment. This work has shown that ECH and ECCD can be highly localized and robustly controlled in toroidal plasma confinement systems, leading to applications including stabilization of magnetohydrodynamic instabilities like neoclassical tearing modes, control and sustainment of desired profiles of current density and plasma pressure, and studies of localized transport in laboratory plasmas. The experimental work was supported by a broad base of theory based on first principles which is now well encapsulated in linear ray tracing codes describing wave propagation, absorption, and current drive and in fully relativistic quasilinear Fokker–Planck codes describing in detail the response of the electrons to the energy transferred from the wave. The subtle balance between wave-induced diffusion and Coulomb relaxation in velocity space provides an understanding of the effects of trapping of current-carrying electrons in the magnetic well. Strong quasilinear effects and radial transport of electrons, which may broaden the driven current profile, have also been observed under some conditions and appear to be consistent with theory, but in large devices these are usually insignificant. The agreement of theory and experiment, the wide range of established applications, and the technical advantages of ECH support the application of ECH in next-step tokamaks and stellarators.