Our understanding of the pathophysiology and clinical consequences of atrial fibrillation has led to an evidence-based revolution in the management of atrial fibrillation over the last decade. As we improve in our ability to detect recurrent atrial fibrillation and treat it definitively, the patients who benefit from long-term anticoagulation may change. We can expect, however,that stroke prevention through systemic anticoagulation will be a cornerstone of atrial fibrillation management for decades to come. Innovations in anticoagulation therapy will make the use of these medications safer. Finally, as we further understand the underlying mechanisms of the development of atrial fibrillation, the pursuit of preventative therapy will be an investigational focus of great import.