@loswalt0525 Thanks for your reply. Firstly, I have been on amiodarone. My first PVI failed. I was in the local ER six days after the procedure with a chaotic heart rhythm. My attending actually managed to get ahold of my EP, they talked, and they agreed that amiodarone was it. So, against my druthers, I reluctantly agreed to trial it. It worked well and converted my rhythm during sleep that night (loading dose of 400 mg BID for one week, followed by 200 mg BID until the expected taper at 5 weeks). I knew what amiodarone was and its reputation and potential problems, and voiced them to the internist, but he said it was the right choice, big hammer and all. Fortunately, I didn't suffer any effects. I WAS grateful to finally be off it, as you must understand by now. Then, AF breakthrough two months later and the EP agreed to try again. Second attempt has me in reliable NSR for 3.5 years to date.

Symptoms are the biggie. If they don't seriously degrade your QOL, and you can stomach the odd episode when it comes (and ideally, goes...), then you don't really need an AAR like Tikosyn. (Requires hospital admission for 2/3 days while they load you). You have no experience, apparently, with either flecainide or propafenone, but they may work for you, especially with a prescribed 'PIP' protocol, or pill-in-pocket, to be taken when you want help to bust a new episode. Lots of patients exist, and do well, indefinitely that way....years.

Have you experimented with magnesium supplementation? It might be worth a careful trial. By careful I mean you wouldn't want to be silly and ingest two or three grams of the stuff, especially the citrate formulation which WILL cause gastric upset and very loose stools....really loose. But maybe a 200 mg capsule every other day after a day's loading of 400 mg? This is not advice, just getting you to think of other potentialities that you might wish to learn about, ponder, and then to trial. You should probably run it past your family doctor or a cardiologist first. I doubt they'd disagree.

What would I do, you ask. I was symptomatic. Fortunately, my heart gave up and went to bed at the same time I did, and this was 100% reliable every single night until my second ablation...within three/four minutes I would find my heart in NSR and it was good for the night. A blessing, I know....trust me. But, when conscious and doing things during the day, I was anxious and unsettled, and I felt weird in my chest. It did begin to affect me. Friends told me I looked grey. Oddly, an AAR was never offered to me. My cardiologist just put me on a statin (he suspected ischemia), a DOAC (apixaban, to minimize risk of stroke when fibrillating), and on metoprolol to nub my typical 135-180 HR when fibrillating. Further, my episodes were infrequent....two, three a month at most, and they self-limited inside of a few hours. It was when they went five/six hours that I sought relief at the ER, which was only to monitor and to give me a bolus with yet more metoprolol. I went home at least twice with a prescription for a shrug and told to wait it out. I reverted to NSR every time, usually within another hour or two....probably due to the increase metoprolol.

This is getting long....sorry, I'm windy. Last thing...you say you're in AF lots. That's not great. It runs a higher risk of morphological changes, damaging ones, to your heart's substrate and to the valves, not to mention LA thickening or 'enlargement', which is normally something they measure with advanced AF patients. The greater the enlargement, the more unlikely an ablation is to stop your fibrillation. The greater the enlargement, the higher probability of mitral valve problems....which nobody wants. So, do get in line for a re-do if you can, and hope it works. That you are still in AF after an index ablation, doesn't matter what method was used, means you were not fully ablated, or that your heart is finding new pathways to take over the atrium's rhythm....meaning it's progressing. A successful ablation slows the progression almost to zero, at least for a few years.....if done right.