Limitations
This study has several limitations. Firstly, the present study is a
retrospective observational study with limited sample size.
Consequently, the generalization of these conclusions needs to be
further tested in prospective controlled studies with larger cohort.
Secondly, all patients of the medical treatment group in our study
received rate control therapy. The head-to-head comparison of catheter
ablation over rhythm control medical treatment is warranted. Thirdly,
all patients in catheter ablation group undergo 24-hours Holter
monitoring, rather than implanted loop recorder during follow-up, which
may underestimate the recurrence rate. Fourthly, given the retrospective
nature, the detailed TTE parameters on diastolic function at the end of
follow-up were not available, which limits the further analysis of the
diastolic function changes. Fifthly, the reduction of NT-ProBNP level
may be explained by the reduction of AF burden in catheter ablation
group, aside from the alleviation of HF per se.