@teacher2001 A reasonable question. AF is a progressive disorder. I get arguments, but if you google 'is atrial fibrillation a progressive disorder', you can use your own judgement at the long list of hits on the first page.
It progresses for two reasons, not one: first, your own heart is producing signalling 'rogue' cells that continue to deposit themselves here and there around your heart. Initially they're found in the ostia of the pulmonary veins, and that is the reason why most EPs will initially only do a PVI (pulmonary vein isolation) during their first crack at an ablation for you. Subsequent attempts, if the PVI is insufficient and you continue with AF or flutter (it happens), will involve ablating more and more surface area in the left atrium. This would include the entire posterior wall, the left atrial appendage, the coronary sinus, the septum between the two atria, and even the Vein of Marshall. Eventually, there's simply nothing left to ablate! The second reason is that when you ARE fibrillating, your heart is in the process of 'remodelling' itself with the deposition of collagen and fibrosis in the walls of the atrium, meaning stiffening, and that causes atrial enlargement. The enlargement causes stress and stretching in the annulus surrounding the mitral valve. In turn, that invites mitral prolapse which is, itself, a progenitor of AF. Nice 'n tidy, eh? Double whammy.
Why do many/most ablations eventually fail? Because of the progressive nature of the disorder. And you should realize, and hope that, some ablations literally do last the rest of the natural life of the patient. I know people who have been in NSR after a single (early in its technical application history) ablation dating back 13 or more years! !!! !!!! So, there's hope there. Obviously the earlier you get the ablation, the higher the probability that 'all of it' will be gotten and your heart calms and doesn't produce so many rogue cells in an attempt to keep itself beating. Sounds weird, but that's what I make of it.
However, for most of We the Great Unwashed, we should expect somewhere between 3-6 years typically, and then we experience the dreaded AF coming back one day. I have accepted that it is likely for me. I rue the day, but the odds don't favour my escaping that fate.
Why bother then? There is risk to every intervention, which an ablation surely is. Why not just rely on medication? The answer is that a fibrillating heart is a changing heart with atrial enlargement, prolapse of the mitral valve, and more fibrosis taking place. Eventually, you may end up with heart failure. That would be an early end....probably. Why not control it with drugs? Because the progressive nature of the disorder means that drugs will slowly lose ground and eventually you'll get more AF with its resultant and associated deterioration of the heart. Also, I read anecdotes all the time on the www of people responding poorly, even dangerously, to arrhythmia drugs. Amiodarone is toxic, flecainide invites 1:1 conduction in some patients (to the dismay of their cardiologists), and dofetilide (Tikosyn) is like amiodarone in that it needs to be 'loaded' initially, but unlike amiodarone it needs to be done in a hospital! (Gulp!)
So, the current gold standard of care is to get an ablation. Ablation may not provide a permanent solution, but as long as it lasts it is delaying the further deteriorations cause by atrial enlargement and fibrotic deposition. And who says you can only have one, two, or three ablations? I know people who have had 6 of them. The most highly skilled EPs will know where to ablate additionally as they enter the heart each time. And if you get a total of, say, three ablations in your life until your EP says that's enough, no more, and if each lasts an average of 4 years, you have bought yourself 12 years of NSR and no further deterioration except that of age-related changes to your myocardium. I'd say that those 20-40K hours of bliss are worth three ablations.
Wouldn't you?