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.