Atrial fibrillation is often not only associated with palpitations, but also with hemodynamic detoriation and high incidence of thromboembolic complications. However, since the establishment or maintenance of a sinus rhythm with antiarrhythmic drugs may also lead to an increased mortality, sinus rhythm should only be achieved by external electrical cardioversion and should be limited to those patients who have been shown to, or may be expected to markedly improved by this intervention. Internal electrical cardioversion should be restricted to those patients who fail external cardioversion. Implantable devices to automatically cardiovert atrial fibrillation are still under clinical investigation and will require further evaluation.