Malignant arrhythmias are a common clinical manifestation in elderly patients with cardiovascular disease and an important cause of death. As we age, atherosclerosis and degenerative changes in cardiac structure become more severe, and a series of changes in the electrophysiological properties of the heart’s special conduction system and cardiomyocytes occur, which are particularly serious in the state of concomitant cardiovascular disease. Malignant arrhythmias in the elderly have the following characteristics: 1. Prone to slow arrhythmias As the heart ages, myocardial fibrosis and amyloid degeneration increase, the number of pacing P cells decreases, and P cells become smaller and apoptotic. The heart rate of elderly patients is slower, and they are prone to sinus node dysfunction and cardiac arrest; the atrioventricular node and the Hippocampal system are also prone to fibrosis, steatosis, atrophy and severe AV block and three-branch block. Elderly patients with slow arrhythmias often have dizziness, blackness and syncope as the main manifestations, which are often misdiagnosed as cerebral insufficiency and seen in neurology and cannot be treated in time, and finally even die. 2, prone to malignant ventricular arrhythmias Elderly patients with cardiovascular disease are often accompanied by cardiac insufficiency, with the pathological basis for the occurrence of malignant ventricular arrhythmias; at the same time, elderly patients are prone to repolarization abnormalities, manifested by prolonged QT interval and increased QT dispersion. In addition, elderly patients have reduced control over the sympathetic center of the hypothalamus and are prone to sympathetic storm and sudden death. 3, a variety of arrhythmias are prone to complications Elderly patients with cardiovascular disease are often complex, not only prone to fatal slow arrhythmias, but also often accompanied by atrial fibrillation, ventricular tachycardia and other rapid arrhythmias, bringing some complexity to the treatment. 4, insidious disease, greater risk Because of the high tolerance and low responsiveness of the elderly, the onset of the disease is not easily recognized, palpitations, dizziness, chest tightness and other symptoms are easily misdiagnosed as neurosis and cerebral arteriosclerosis, delaying treatment. For these reasons, it is more important to standardize follow-up and clinical monitoring for elderly patients with cardiovascular disease. For example, patients with atrial fibrillation should be anticoagulated according to risk stratification, patients with recurrent dizziness, blackness, and syncope should be monitored for continuous electrocardiographic activity in a timely manner, risk factors for arrhythmogenic conditions (e.g., prolonged QT interval, frequent premature beats, etc.) should be emphasized, and antiarrhythmic drugs and devices should be administered in a timely manner, but catheter ablation therapy needs to be evaluated carefully.