There are a number of applications for pacemaker therapy in the management of Atrial Fibrillation (AF). The most frequent indication for pacing in AF is to prevent bradycardia in patients with rapid ventricular response and sinus node dysfunction. For elderly patients or patients with significant medical comorbidities who have highly symptomatic, drug-refractory AF, pacemaker implantation and atrioventricular (AV) junction ablation can be an effective alternative therapy. Pacing may also decrease symptoms during atrial fibrillation by regularizing the ventricular rate. Other pacing strategies attempt to decrease AF recurrence, but these algorithms have demonstrated only limited success. Although pacing is generally not considered primary therapy for AF, it may play an important adjunctive role in the management of patients with AF.