Abstract: Objective To analyze disease spectrum, clinical classification and trends of elderly patients hospitalized with arrhythmia during recent ten years. Methods The discharged medical records of the elderly patients (≥ 60 years old) with principle diagnosis of arrhythmia in our hospital from 2005 to 2014 were collected, then they were classified by the underlying mechanism (abnormal origin of exciting, abnormal conduction, or both) or heart rate at attack (tachyarrhythmia, bradyarrhythmia). Diagnosis, age and cause of death at different classification or discharge period were analyzed and compared. Results A total of 1 157 eligible cases with the average age of (83.10±8.49) years were included, and 72.60% of whom were ≥ 80 years old. Fifteen cases (1.29%) died with age more than 80 years old. Atrial fibrillation ranked the first in causes of admission and death across all age groups in recent ten years. With the advancing of age, hospitalizations with sick sinus syndrome and atrioventricular block showed increasing trend, while premature beats and sinus arrhythmia showed decreasing trend in recent five years (2010-2014). Abnormal origin of exciting induced arrhythmia was the main cause of admission which increased with age. Tachycardia accounted for 79.08% of causes of admission, among which atrial fibrillation ranked the first (61.09%), followed by premature ventricular contractions (15.08%). Sick sinus syndrome and atriventricular block accounted for 75.62% of bradyarrhythmia. Conclusion Atrial fibrillation is the leading cause of admission and death in elderly patients hospitalized with arrhythmia. Abnormal origin of exciting and tachyarrhythmia are prominent investigated patients.