There are scads of rate control and anti-arrhythmic medications. Bisoprolol, diltiazem, propranolol as examples of the former, and Tikosyn, Multaq, propafenone, and amiodarone, with the latter the AAR of absolutely last resort due to its inherent toxicity. I have no experience with any except amiodarone (long story), but was on it only seven weeks...thank God. I read that Tikosyn needs a hospital stay at startup, and also Sotalol.

The rationale for and against any of the interventions, medication or ablation, or even the drastic step of a pacemaker (usually means destroying the AV node, the SA node, or both), depends on age, other comorbidities, foreseeable interventions for other conditions, available support and monitoring, prognosis, and stage of life. Some can get by on self-regimented care without drugs, or with PIP (pill in pocket, usually a single dose of Flecainide). Others are so heavily symptomatic that they need relief or they'll be hospitalized ere long anyway due to anxiety and emotional distress, or for lashing out and getting the Law involved. Some can't/won't take any drugs whatsoever, for any reason, and they'll have a choice of pacemaker, living with it anyway, or getting the mechanical intervention which is catheter ablation. I chose ablation over medication even though the medication sort of took care of my symptoms and arrhythmia for about four years until things began to deteriorate quickly.

Many, many people are on Flecainide or something else. Why? Because it works. It's also almost always better than the alternative, which is to risk heart failure, atrial enlargement, mitral valve prolapse, and progression to more intractable forms of AF. In the event that Flec doesn't work, try another one. It might be the ticket.

No matter what, each of us is in the driver's seat. We elect to undergo or to forego as we choose. nobody in the cardiac world will hold our feet to the fire. They can assess us, and then recommend what they think is the best way forward. If one disagrees, then it's on them to live as they are wont.