The objective of treatment in atrial fibrillation (AF) is two-fold: firstly, to reduce symptoms by control of the rhythm or heart rate, and secondly, to avoid cardioembolic events. Structural modifications to the elderly heart, particularly in the atria, tend to plead in favour of rate control in geriatric patients, because a return to, or maintenance of sinus rhythm is often difficult, not to say impossible. In the majority of cases, long-term oral anticoagulant therapy is required.