Rate control may now be adopted as a first-choice therapy in a variety of patients, especially older relatively asymptomatic patients with hypertension or other underlying heart diseases. The goal of rate control therapy is to minimize symptoms, improve quality of life, decrease the risk of development of heart failure, and prevent thromboembolic complications. A lenient rate control approach may be the initial therapeutic strategy. If symptoms persist, a stricter rate control approach may be adopted. Although long-term randomized studies are lacking, the evidence available suggests that a β-blocker with or without digoxin is the first-choice rate control therapy.