@sandw40 The various causes of AF are not mysterious. The various triggers that people swear set them off are somewhat of a mystery because we're all so different, but the causes of AF are well-established: cardiomyopathy, mitral valve prolapse, pathogen, systemic inflammation, and several other comorbidities. The real cause of atrial fibrillation is the establishment of routes for the spurious signals to enter the atrial endothelium which causes extra beats above those enabled by the SA and AV nodes. https://www.nhlbi.nih.gov/health/atrial-fibrillation/causes The risk factors are also numerous, some of which I have already mentioned.

It is precisely because the disorder is progressive that drugs lose their efficacy over time, again with the majority of patients. It's progressive nature is also why, as you say, that most treatments are temporary. As the disorder takes over more and more walls of the atrium, it begins to overcome the intended effects of medications of all kinds. It becomes more resistant to any treatment, including ablations. But there is one important saying in the field, 'AF begets AF.' The longer you're in AF, the more likely you'll stay in AF or at least continue to build the amount of time you're in AF. So, ablations, for the most part, stall that progression for many/most patients, maybe only for three years, while some get relief for a decade or more.

And yes, you're right, some patients have a cardioversion at the local ER and never have another blip as long as they live. I know one person who drinks a liter of magnesium water every/most days, avoids overconsumption of calcium by mouth, and is AF free for many months at a time. He uses a 250 mg flecainide tablet as a PIP (pill in pocket) if he's out and about and his heart begins to fibrillate, which he says happens about once or twice a year. He takes no medications, nada, except for the flecainide when needed, and has never submitted to an ablation.