@evelynd It is a progressive disorder for the vast majority of AF patients. It is almost certain to get worse if it is not 'checked', and the best way to do that is with an ablation. My understanding is that an ablation fails if it does not block, or corral, the re-entrants where the signal comes into the left atrium and takes over or coerces its rhythm. The reason is that there is more than one wall, of the six in a left atrium, that has these foci and the electrophysiologist (EP) has missed one or more of them and they're still freely signalling the myocardium to beat at they command it to. A third ablation might do the trick, but I would consider seeing a new EP who is known to subdue 'complex cases', which you appear to be.

My first ablation was a bust, and I had been sliding downhill quickly by the time it came about. Inside of six days I was in the local ER experiencing long pauses because the EP team had left me on 50 mg of metoprolol BID in case I had the typical breakthrough AF that often happens in the first three/four weeks after an ablation....I had RVR and my rate was always 140 plus, sometimes 180 (RVR is 'rapid ventricular response' and is indicated when one's AF rate exceeds 100-110 BPM). So the metoprolol was a prophylactic against that high rate. Turns out the pauses were caused by that same medication, so I went on amiodarone that very day, and stopped metoprolol completely...cold.

Second ablation, same gentleman EP, worked, and I am within six weeks of being AF-free for three full years. I think you can get there, but you might need a fresh approach, certainly one willing to accept that you have multiple foci that have been missed.

Note that I am not medically qualified....at all. No medical training. But I have done a lot of self-teaching on heart arrhythmia, mostly about flutter, PACs, and AF.