Reasonable question!

AF begets AF. That's Rule 1. So.....try not to be in AF.

Easily said, not so easily done. Initially, when you are still paroxysmal (it comes and corrects itself on a whim), you needn't be concerned. It is as the disorder evolves to persistent, long-standing persistent, and finally to permanent that you should seek perhaps an ablation, or maybe just a different medicine regimen...whatever you agree to use. (It's always a personal decision!)

AF is a progressive disorder, and it has potential dangers. First is the clotting risk, and that has been addressed with the apixaban. Secondly, diltiazem has both a rate control factor and a mild rhythm control effect. From what I have heard, it's a good drug. But, if you would rather not be on drugs, and don't mind the idea of a catheter ablation, the latest literature says that a catheter ablation is the 'gold standard' for treatment of AF.

Bottom line, you want to get a firm grip on the disorder, and you want to be in AF as seldom as possible. If you find you're losing ground and are getting more frequent and/or lengthy bouts of AF, despite drugs, then you should probably consult a good electrophysiologist nearby, or travel to the best, and get ablated. I have had two ablations, and only the second worked. Same physician EP, same hospital, but it took a first (AKA 'index') ablation to learn that I needed more work than what he did the first time. Fortunately, the second time worked like a charm and I have been off everything except apixaban ever since.

PFA is new, but they continue to advance the procedure all the time. I learned just the other week that it is now approved for, not only the standard PVI (pulmonary vein isolation), but also to isolate the left atrial appendage (LAA). PFA's advantage over the thermal/RF ablation is that there is much less risk of damaging the Vagus and phrenic nerves, and of the esophagus. Accordingly, they don't necessarily have to insert a trans-esophageal cardiogram probe down your throat while you are out and being ablated (the TEE allows them to monitor how close the burning needle is to those sensitive non-targets).