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Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1∶1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitaliza-tion.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75 ± 19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)= 0.49,95％confidence interval(CI):0.30-0.79,P = 0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR = 0.25,95％CI:0.11-0.61,P = 0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR = 0.79,95％CI:0.48-1.28,P = 0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR = 0.84,95％CI:0.67-1.04,P = 0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.