Abstract ECG steganography allows secured transmission of patient data that are tagged to the ECG signals. Signal deterioration leading to loss of diagnosis information and inability to retrieve patient data fully are the major challenges with ECG steganography. In this work, an attempt has been made to use curvelet transforms which permit identifying the coefficients that store the crucial information about diagnosis. The novelty of the proposed approach is the usage of curvelet transform for ECG steganography, adaptive selection of watermark location and a new threshold selection algorithm. It is observed that when coefficients around zero are modified to embed the watermark, the signal deterioration is the least. In order to avoid overlap of watermark, an n × n sequence is used to embed the watermark. The imperceptibility of the watermark is measured using metrics such as Peak Signal to Noise Ratio, Percentage Residual Difference and Kullback-Leibler distance. The ability to extract the patient data is measured by the Bit Error Rate. Performance of the proposed approach is demonstrated on the MIT-BIH database and the results validate that coefficients around zero are ideal for watermarking to minimize deterioration and there is no loss in the data retrieved. For an increased patient data size, the cover signal deteriorates but the Bit Error Rate is zero. Therefore the proposed approach does not affect diagnosability and allows reliable steganography.