Abstract： Objective:To investigate the prevalence, clinical characteristics and outcomes of non-pulmonary vein (PV) triggers in older patients with paroxysmal atrial fibrillation (PAF) .Methods:This is a retrospective cohort study. Older patients with PAF who underwent their first catheter ablation at the Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University from January 2018 to June 2021 were enrolled. All patients underwent a successful circumferential pulmonary vein isolation (CPVI) procedure guided by 3D mapping system. If low-voltage areas (LVA) were detected within the left atria, substrate modification was applied. Additional ablation was performed simultaneously if non-PV triggers were spontaneously presented or induced by programmed and pharmacological stimulation. The prevalence and distribution of non-PV triggers were documented. The primary endpoint of the study was freedom from atrial tachyarrhythmia (ATA) as determined by electrocardiogram documentation or lasting longer than 30 s during Holter recordings following a single-ablation procedure.Results:The study included 738 older patients with PAF [385 males, mean age (70.0±3.9) years]. Among them, 679 patients did not exhibit non-PV triggers (Group I), while 59 patients showed non-PV triggers (Group Ⅱ). There were no statistically significant differences in baseline characteristics between the two groups ( P>0.05). The incidence of non-PV triggers in older patients with PAF was approximately 8%, with the most prevalent locations being the superior vena cava (49.3%, 33/67), the crista terminalis (14.9%, 10/67), and the fossae ovalis (11.9%, 8/67). Additionally, non-PV triggers were found in other areas, including the left atrial appendage, septum, right atrial appendage, posterior wall of the left atrium, coronary sinus, free wall of the right atrium, persistent left superior vena cava, mitral annulus, and the roof of the left atrium. The proportion of LVA was similar between the two groups [37.1% (252/679) vs. 28.8% (17/59), P=0.204]. After a follow-up of 14.0 (12.0, 26.2) months, there was no significant difference in the rate of freedom from ATA recurrence between Group I and Group Ⅱ [74.9% (484/646) vs. 71.9% (41/57), P=0.459] . Conclusion:The prevalence of non-PV triggers in older patients with paroxysmal AF was relatively low and mainly located in the superior vena cava. Clinical outcome of ablation of non-PV triggers after CPVI combined with non-pulmonary vein triggers ablation is promising.