Recent randomized trials have not demonstrated mortality or stroke risk reduction benefits from a rhythm-control compared to rate-control strategy in the treatment of atrial fibrillation. These studies reinforce the need for continued anticoagulation in both strategies for patients with atrial fibrillation and risk factors for stroke. Although rate control can be rationalized as a first line approach, rhythm control strategies may be justified for patients who are younger, who remain symptomatic or functionally impaired, or who have a first episode of atrial fibrillation.