Atrial fibrillation (AF) is a common cardiac arrhythmia that becomes more common as patients get older. We review the common factors associated with AF and hemodynamic abnormalities. In addition, we discuss practical management issues concerning treatment of patients with rapid, hemodynamically significant AF, as well as patients with hemodynamically stable AF. The strategies of rhythm control and rate control and the different modalities available for use with each strategy are presented. Issues related to stroke prevention in AF are reviewed.