In patient’s ≥ 65 years, Atrial Fibrillation (AF) prevalence is high and increases further with age. Now-a-days, it has been estimated that AF affects 5% of ≥ 70-years patients, while approximately 10% of patients aged ≥ 80-years suffers from this arrhythmia. Evidence suggests that elderly people are predisposing to AF, due to aging-related cardiovascular remodelling and modifications. Symptoms due to AF could be directly caused by arrhythmia, such as palpitation, or indirectly by exacerbating other conditions such as angina, heart failure and structural cardiomyopathy. Since 2000’s, novel drugs and therapies have become available also for the elderly but, unfortunately, have not been extensively evaluated in this population. Particular interest should be payed to emerging pharmacological and nonpharmacological treatment for AF, such as dronedarone or catheter ablation, and their perspective in the older patients. However, the absence of clear superiority of rate control or rhythm control strategy in the elderly makes particularly difficult the choice of an appropriate treatment. The pathophysiology, diagnosis, and the management of AF in older patients are reviewed in this paper.