Objective: To analyze the value of electrocardiogram (ECG) f-wave amplitude in predicting 1-year recurrence after radio frequency catheter ablation (RFCA) in elderly patients with persistent atrial fibrillation (PsAF). Methods: Patients aged ≥60 years who were diagnosed with PsAF and underwent RFCA in the First Affiliated Hospital of Nanjing Medical University from September 2014 to May 2022 were enrolled. Based on 1-year follow-up, patients were divided into two groups: the recurrence group and the non-recurrence group. The clinical characteristics of both groups were analyzed, and indicators showing significant differences were further examined using logistic regression analysis. Results: A total of 369 patients were included, among which there were 281 cases (76.15%) in the non-recurrence group and 88 cases (23.85%) in the recurrence group. There were no significant differences between the two groups in terms of age, body mass index, comorbidities, left ventricular end diastolic dimension, left ventricular ejection fraction, pulmonary artery pressure, Pro-BNP, uric acid, and low-density lipoprotein cholesterol, antiarrhythmic drugs (all P > 0.05). Compared with the non-recurrence group, the recurrence group had higher female ratio (39.77% vs. 26.69%, P=0.019), a longer duration of atrial fibrillation[15.5(6.00, 51.00)months vs. 9.00(3.00, 24.00)months, P < 0.001], lower f-wave amplitude in lead Ⅲ [0.07(0.06,0.08)mV vs. 0.09(0.08,0.11)mV,P < 0.001], lead avF[0.06(0.05,0.07)mV vs. 0.08(0.07,0.10)mV,P < 0.001], and lead V2[0.07(0.06,0.09)mV vs. 0.10(0.08,0.12)mV,P < 0.001], larger LAD[43.00(40.25,46.00)mm vs. 42.00(40.00,45.00)mm, P=0.039] and RAD[41.00(39.00, 43.75)mm vs. 40.00(39.00, 42.00)mm, P=0.038]. Logistic regression analysis identified atrial fibrillation duration as a risk factor for recurrence in elderly patients, while f-wave amplitudes in lead V2 and avF were independently negatively correlated with 1-year recurrence after radiofrequency ablation. Conclusion: The ECG f-wave amplitudes and atrial fibrillation duration may serve as predictors of the outcome of RFCA in elderly patients with PsAF.