I am 71 and have been in permanent AF since December 2007. My symptoms are minimal unless I want to exert myself physically, e.g., walk up hills, ride my bike fast or on hilly terrain or jog. I did all of those things before the permanent AF. In normal walking around and doing light chores (yard and house) I am mostly fine.
I take a beta blocker and a calcium channel blocker to lower my (ventricle) heart rate and I take 5 mg of Warfarin and a half 325 mg aspirin a day to reduce blood clot risks. Both my long time cardiologist and the consulting EP do not recommend an ablation; they believe my risk/benefit results are too high....risk too high for the possible benefits, and assumed % of successful results. Of course they are making a "benefit" evaluation form the third-party perspective. I am inclined to think that the low Medicare payment rates make the procedure less attractive to the surgeon (EP) as well. If they are that busy ablating people who pay higher rates and/or have a lot worse symptoms it may be a reasonable decision. I think it is going to get a lot worse in the USA (especially at advanced age) going forward. Said another way, in a few years you may not have a choice unless you are willing to pay out-of-pocket the "full rate"... just my reading on where his country is headed.