Atrial fibrillation is one of the most common long-lasting arrhythmias of the heart. It leads to an increase in morbidity and a substantial reduction in quality of life in most patients. Therefore, an early and adequate therapy strategy and prevention of comorbidities of atrial fibrillation are demanding. There is no controversy about the pharmaceutical treatment as the first choice and gold standard in atrial fibrillation patients. As there is no evidence that frequency control is superior to rhythm control or vice versa, therapy strategies should depend on the clinical status and comorbidities of the individual patient. However, adequate anticoagulation for prevention of thromboembolism should be performed in every patient, even after conversion of atrial fibrillation into sinus rhythm.