OBJECTIVES: Treatment strategies for atrial fibrillation (AF) are classified into rate control and rhythm control. They can be employed through the use of pharmacological and non-pharmacological approaches. This study described the trend in the utilization of treatment strategies for the management of AF in newly diagnosed patients between 1999 and 2008.  METHODS: The study was a retrospective cohort study of administrative claims data from a large nationally dispersed group of commercially insured subjects from 1999-2008. Newly diagnosed AF patients aged ≥18 years and with at least one claim for an AF related intervention within 12 months of diagnosis were identified. Based on initial treatment received, patients were classified in pharmacotherapy or non-pharmacotherapy treatment groups. Patients initiated on drug-therapies were classified into rate-control (beta-blocker, calcium channel blocker or digoxin) or rhythm control groups. Descriptive analysis was conducted to compare the patient demographic characteristics across the treatment groups. OLS regression was conducted to assess linear trends.  RESULTS: Of the 6284 newly diagnosed AF patients who received treatment within one-year, 83.7% underwent pharmacotherapy as the 1st line therapy. Majority (86.3%) of patients who initiated drug therapy received rate-control medications only. Relative distribution of different treatments across time did not vary significantly. However, within rate-control group, beta-blockers use increased significantly (p <0.0001) from 47.5% (1999) to 70.58% (2008), whereas use of calcium channel blockers and digoxin decreased. Non-pharmacotherapy was employed more commonly in the mid-west (44.95%, p <0.0002), in patients younger than 65 years (58.35%, p <0.0001) and its use decreased with increasing age. Males were more likely to undergo non-pharmacotherapy (69.9%, p <0.0001). CONCLUSIONS: Higher utilization of rate control as 1st line therapy compared to other treatment strategies is consistent with the current literature. Greater use of non-pharmacotherapy in younger patients can be partially explained by the higher success rate in this population.