Atrial fibrillation and heart failure have been called the twin cardiovascular epidemics of the 21st Century. The prevalence of both conditions is increasing in the elderly and often the two conditions coexist in the same patients, leading to worse outcomes. Current data show that rate control and rhythm control are both reasonable strategies for the treatment of atrial fibrillation in heart failure patients. Emerging data suggest the beneficial effects of novel therapeutic approaches such as cardiac resynchronization therapy, and pulmonary vein isolation on left ventricular remodeling and functional outcomes. Anticoagulation remains a mainstay of therapy for stroke prevention in this high-risk population.