I am not in your circumstances, although I am a 'recovering' AF patient. Two ablations, second was the one that has me in NSR for just over three years now.

I have seen posts by forumites claiming they accepted the recommendation of a cardioversion years into what was essentially permanent AF and.....darned if it didn't work! My experience, still very happily in the early 'paroxysmal' stage, was the opposite. None of them worked, four them. The longest I was in NSR was 16 hours, the shortest was that none of the three zaps brought me back to NSR. To add insult to injury, I came to from the dose of propofol just as the tech pressed the button for the third, and strongest, jolt. NOT a happy experience!!!

With your ejection fraction, possible/probable atrial and/or ventricular enlargement, but with a sound mitral valve (?), you might be a long shot for ablation, which is probably what you have been told? Guessing? In any event, usually ablating a long-standing persistent or permanent AF patient is at best a crap shoot. The very best EPs money can buy might do well, but that eliminates 90% of us.

A cardioversion is cheap medicine, and for many it actually works. I feel that, aside from the bother of that day if you elect to have one, it might work, and you otherwise lose only several hours of that day. And, further, an ablation might still work. Even if it reduces your burden by only 50%, that may delay any usual degradation of the myocardium, or what they call 'remodeling'. Again, you have much to gain, and only the cost and the bother of it all to lose. But, you'd have to meet that one EP within a short flight or a day's drive who feels he/she wants to try because their record of success for 'complex cases' is rather good.