Management of atrial fibrillation in the elderly presents unique challenges, including deciding upon the best treatment strategy: rate control versus rhythm control. The decision to pursue one treatment strategy over another is based on understanding the underlying disorder: symptomatology from atrial fibrillation itself versus symptoms due to a rapid ventricular response from atrial fibrillation. The ablation strategies for the treatment of atrial fibrillation include atrioventricular junction ablation and pulmonary vein isolation. This review discusses the data on ablation of atrial fibrillation in the elderly, with an emphasis on issues regarding safety and efficacy in this population.