Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice affecting up to 1% of the general population. There is a higher prevalence and incidence with increasing age and burden of chronic heart disease . Treatment for AF represents a significant healthcare cost, estimated to be about Euro 13.5 billion annually in the European Union. Manage-ment of AF remains challenging especially with new pharmacological and non-pharmacological approaches becoming readily available. This review article discusses the multitude of therapeutic options and how they may be applied to best effect.