@nfsandf A cardioversion might work, and I can see why you 'd want to give it a try. I have no idea why it wasn't offered to you. Your long-term AF means that you may......important....MAY...have moved through paroxysmal AF and are now in long-standing persistent which makes it trickier to treat medicinally and through catheter ablation. The best electrophysiologists can probably help, but you'd need access to them.

This is just untrained me, but I would press hard for a single cardioversion attempt, and if it just doesn't fly from the cardiologist's point of view (I'd want that carefully explained to me so that I can put it to rest/poll another cardiologist/EP), have a strong personal reason for declining Flecainide, Sotalol, Multaq, or propafenone. Note that I have no idea if you have other comorbidities or cardiomyopathy, structural problems like valves that need attention....so maybe that's why Sotalol is a best fit for you.

Last point: AF is considered to be a progressive disorder. I don't know how you feel about just winging it from here and living with it, including if/when it becomes classified as 'permanent.' But, the progressive nature means it encourages what is called 'remodeling' of the substrate, the tissue below the endothelial linings of each of the four chambers. Their walls can become 'enlarged' or thickened, which tends to reduce blood volume internally. They develop fibrosis, and AF can affect the mitral valve adversely in time. I would desire to be free of that risk to the extent possible, so I would opt for either anti-arrhythmic drugs or a catheter ablation. I have had two of the latter, and have been free of AF for just over three years now.