Aim To explore the association between mental health status and post-ablation recurrence in elderly atrial fibrillation patients. Methods Consecutive patients aged≥60 years who underwent catheter ablation for atrial fibrillation in Beijing Anzhen Hospital were enrolled, baseline clinical characteristics, comorbidities and treatment were collected. Five item mental health inventory (MHI-5) was used to evaluate the mental health status, and 76 points were taken as the cut-off value. Each patient was followed up at 3,6 and 12 months after ablation to assess atrial fibrillation recurrence, mental health status and other adverse events. Multivariate Logistic regression analysis was conducted to examine the association between mental health status and the risk of atrial fibrillation recurrence. Results A total of 238 elderly patients with atrial fibrillation were enrolled, including 58 patients in the MHI-5≤76 points group and 180 patients in the MHI-5＞76 points group. During 12 months follow-up, 73 patients (30.7%) developed atrial fibrillation recurrence, and the recurrence rate in the MHI-5≤76 points group was significantly higher than that in the MHI-5＞76 points group [58.6%(34/58) vs. 21.7%(39/180), P＜0.001]. Multivariate Logistic analysis showed that after adjusting for demographic data and clinical factors, MHI-5≤76 points was significantly associated with a higher risk of atrial fibrillation recurrence after catheter ablation (OR＝6.3,5%CI:3.08～12.24, P＜0.001). Conclusion Poor mental health status is significantly associated with higher post-ablation recurrence in elderly atrial fibrillation patients.