Objective To investigate the clinical outcomes of radiofrequency ablation in elderly patients with paroxysmal atrial fibrillation and its effect on prognosis. Methods A total of 450 patients with paroxysmal atrial fibrillation who underwent radiofrequency ablation in our hospital from September 2014 to September 2019 were recruited in this study. According to their age, they were divided into non-elderly group (<60 years, n=240) and elderly group (≥60 years, n=210). After radiofrequency catheter ablation, the patients from the both groups were given routine anticoagulation and antiarrhythmic drugs. The ablation time, operation time, intraopera-tive exposure time, length of hospital stay, conversion rate and immediate success rate were observed for both groups. The P-wave maximum duration (Pmax), P-wave dispersion (Pd) and left atrial diameter (LAD) by echocardiography before and after surgery, incidence of operative complications during hospitalization and outcomes within 1 year after surgery were compared between the two groups. SPSS statistics 22.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for intergroup comparison on different data types. Results There were no statistical differences in ablation time, operation time, intraoperative exposure time, hospital stay length, conversion rate, and immediate success rate between two groups (P>0.05). The Pmax, Pd and LAD were significantly decreased in both groups after operation (P<0.05); but there were no significant differences in above indicators between two groups at the same time points (P>0.05). The total incidence of complications was 8.75% (21/240) and 21.43% (45/210), respectively, in the non-elderly group and elderly group, with significant difference (P<0.05). The incidence of bradycardia and recurrence were 10.00% (24/240) and 7.50% (18/240) in the non-elderly group, which were significantly lower than those in the elderly group [22.86% (48/210) and 17.14% (36/210), P<0.05]. But there were no obvious differences in the incidence of secondary hospitalization [11.25% (27/240) vs 15.71% (33/210)] and secondary surgery [7.50% (18/240)vs 11.90% (25/210)] between two groups (P>0.05). Conclusion Age difference does not affect the short-term clinical efficacy of radiofrequency ablation in patients with atrial fibrillation and the improvement of P wave, but the elderly patients may have higher incidence of complications and recurrence, and poor long-term prognosis, which deserves attention from clinicians.