Objectives <p>To investigate the prevalence, distribution and ablation of non-pulmonary vein (PV) triggers in older patients with paroxysmal atrial fibrillation (AF).</p> Methods <p>A total of 694 patients aged 65–80 receiving index ablation for paroxysmal AF were included. These patients were divided as follows: patients without low-voltage areas (LVA) (<i>n</i> = 437), LVA patients with modification (<i>n</i> = 175), and LVA patients without modification (<i>n</i> = 82). Following propensity score matching (PSM) analysis, two sets of matched groups emerged: LVA patients without modification (Group A, <i>n</i> = 77) and patients without LVA (Group B, <i>n</i> = 77), and patients without LVA (Group C, <i>n</i> = 168) and LVA patients with modification (Group D, <i>n</i> = 168). The clinical endpoint was defined as the detection of ATA lasting longer than 30&#xa0;s through ECG documentation or Holter recordings following the index ablation.</p> Results <p>Fifty-seven (8.2%) patients were identified with non-PV triggers, mostly originating from superior vena cava (SVC). Compared with Group A, Group B exhibited a higher prevalence of non-PV triggers (18.2% vs. 6.5%, <i>p</i> = 0.027). Likewise, Group C showed a higher prevalence compared with Group D (14.3% vs 7.1%, <i>p</i> = 0.034). Over a mean follow-up of 19.7&#xa0;months, there was no significant difference in ATA recurrence between patients with non-PV triggers ablation (<i>n</i> = 57) and without non-PV triggers (<i>n</i> = 637) (71.9% vs 74.9%, <i>p</i> = 0.458).</p> Conclusions <p>Among older patients with paroxysmal AF, non-PV triggers exhibit a lower prevalence, originate mostly from SVC, and present less frequently in patients with LVA.</p> Graphical Abstract <p></p>