Prophylactic treatment for atrial fibrillation (AF) should be considered if the arrhythmia is ill tolerated by the patient. Without treatment it will recur in 80-90% of patients within one year. Prophylactic treatment should be planned individually for each patient, bearing in mind the need to control any predisposing factors, e.g. electrolyte or endocrinological disturbances or myocardial ischaemia.Antiarrhythmic drugs are only seldom able to totally eliminate episodes of AF and, therefore, symptom relief and more infrequent episodes should be considered as realistic treatment goals. If there is no response to drug treatment, the patient should be referred to a cardiologist specialized in rhythmology to assess the need of catheter ablation or other invasive treatments.