Cryoballoon ablation (CBA) results in satisfactory outcomes for drug-resistant atrial fibrillation (AF) patients. However, the efficacy and safety of CBA have not yet been tested in the Chinese elderly population. Therefore, this study compared the recurrence of AF and complications of CBA in patients ≥ 75 years and <75 years.A total of 677 patients (<75 years, n=550; ≥75 years, n=127) with paroxysmal (n=603) or persistent (n=74) non-valvular drug-resistant AF were included. The efficacy was assessed by the recurrence of AF, and the safety was evaluated by peri- and post-procedural complications.The CHA2DS2-VASc (2.6±1.7 vs 4.8±1.6, p<0.01) and HAS-BLED (1.8±0.8 vs 2.0±0.8, p=0.01) scores were significantly higher in the elderly group. The instant pulmonary vein isolation (PVI) success rate was comparable (99.11% younger vs 98.98% older, p=0.99). After a mean follow-up time of 12.8±9.6 months, the 1-year freedom from AF rate was 80.6% vs 85.8% in the older and younger groups, respectively, while the survival analysis showed a non-significant difference in the rate of freedom from AF (log-rank P=0.46). Cox regression showed that age was not a predictive factor for AF recurrence and was not dichotomized (hazard ratio (HR)=0.868, 95% confidence interval (CI) 0.509-1.481 p=0.6046) or continuous (HR=0.990, 95% CI 0.968-1.012, p=0.3642). Similar complications rates were observed, including stroke (1.0% younger vs 0.93% older, P=0.95) and major hemorrhagic event (1.2% younger vs 0% elder, P=0.25).The efficacy and safety profiles of CBA in patients older than 75 years are comparable with those in younger patients. This article is protected by copyright. All rights reserved.