As a general rule, treat AF early. However, too early may mean that your re-entrant foci will be difficult to locate, and an EP doing ablation might just default to a simple PVI (pulmonary vein isolation) because that is where the re-entrant for the AF-inducing signal is found in the heavy majority of patients...at first.

As you know, an ICU nurse (bless you!), symptomology, the worst of it, drives a LOT OF medicine. You say you tolerate AF reasonably well. I didn't, and won't if I have any say in the decision-making that follows. But you do okay, and there's no harm, in my thinking, to staying calm, minimizing medicines (except apixaban or rivaroxaban...those you should take if you ask me for my opinion). It is when your AF begins to be intrusive, to come maybe two/three times each week...that is when you might want to enlist the help of a really top-notch EP who can offer you relief, but also help to stem the onset of heart insufficiency or mitral valve prolapse...IF...IF... those lie ahead of you (we're all on our own journeys with our aging hearts, so our stories will differ).

You are your own best coach. I think you are dealing with this sensibly. Just, please, don't err on the side of caution and let your heart get too far into AF before you recognize that it's time for an ablation, or some other remedial measure, including anti-arrhythmic drugs. Spend as little time in arrhythmia as you can so that you don't speed or encourage the remodeling that is sure to take place with collagen deposition interstitially and with fibrosis.

Take a look at John Mandrola online. He writes for Medscape and also on Sensible Medicine on Substack. He’s an electrophysiologist and has written a great book on Afib aimed at athletes but good for anyone who has or has had Afib episodes.

I have only had two episodes 11.5 years apart, the last one 5 years ago. Mine were both brought on by high stress. The cardiologist here agreed that if I had another episode, I could take Eliquis for 5 days afterward as a kind of pill in the pocket type of thing and not have to go on it full time (often recommended for a woman of my age: 74). I do get the sometimes triplet or octet beats and was told I have SVT (Supraventricular tachycardia) but those very short fast heartbeat runs are also sparse and my electrophysiologist isn’t concerned about them. I’ve been taking one 25 mg extended release metoprolol beta blocker and one 25 mg losartan for BP daily ever since that first Afib episode over 16 years ago. I don’t tolerate beta blockers well but the extended release form doesn’t knock me out as much and both meds are the lowest dose, albeit I can take as little as a half beta blocker as it is scored and allowable.

I’ve been following Mandrola as well as the Skeptical Cardiologist who is also online, for years. They stay up to date and are conservative physicians but also willing to change their minds on an issue if robust studies warrant it. Mandrola especially is rabid about the importance of well designed studies.

I walk my dog daily although with a wonky spine these days I use a Swedish designed Trionic Veloped all terrain rollator for additional support. It allows me to easily go a mile or more walking. I also practice chair yoga 3-4 times a week with the online program YogaVista…tons of online classes with various teachers (I like the founder, Sherry Zak’s classes the most). Very inexpensive and all classes are recorded and available 24/7. I save my favorite classes to repeat. I turn 74 in a few days and have been surprised at my body’s aging process which of course I never thought would happen to me! I was always very active but have had to adapt to less forceful activities than I did in the past. Adaptation is good though and I’m able to stay active in this manner which I can only believe is also good for my heart.

Like you, I believe that knowledge is power. Finding good, reliable knowledge can be difficult but it sounds like you stay informed via excellent resources as well.