Currently, there are more therapeutic options available for AF patients with recurrent symptomatic AF episodes. The studies on the role of device therapy for AF have been promising thus far, but they have not achieved any of the goals of AF management. Based on large randomized clinical trials, patients with SSS should receive atrial-based pacing devices. Moderate sized randomized studies have shown minimal benefit of multi-site pacing in AF prevention, even when combined with antiarrhythmic agents. Alternative site pacing such as septal pacing (high or low), however, may be more advantageous, as it achieves similar results in terms of AF reduction with less hardware. The role of ATP in AF prevention is still in its infancy and will need further studies to determine its role in conjunction with antiarrhythmic agents. Furthermore, the role of radiofrequency ablation of pulmonary veins and other sites of AF initiation has been evolving and may be offered to more patients in the future. This approach may be more acceptable to patients and may gain wider acceptance for some groups of AF patients rather than device therapy. In any event, there is still a large role for pacemaker therapy in the management of AF, especially in patients who cannot benefit from curative ablation or surgery procedures, or patients who have failed these procedures, and particularly elderly patients who typically do not undergo these procedures. Based on current understanding, careful selection of pacing sites and pacing algorithms may help in reducing AF episodes in patients receiving devices.