As new therapies for cardiovascular disease develop, there has been a shift in the epidemiology of cardiovascular complications. The global population is living longer, and as a result myocardial dysfunction and arrhythmia are a growing pandemic. Congestive heart failure is increasingly common with an estimated prevalence of 20 million people worldwide, while atrial fibrillation (AF) has the highest prevalence of all sustained arrhythmias, affecting 1.5% of the population of the United States.¹ AF may be found alone; however, more often than not, it is both a marker and precipitant of left ventricular dysfunction.² Indeed, the prevalence of AF in left ventricular dysfunction ranges from 5 to 65% and appears to be dependent on the severity of heart failure and patient age.^2,3 The incidence of AF complicating myocardial infarction is estimated to be between 2.3 and 21%.⁴ The association between AF and myocardial infarction should come as no surprise, as they share common risk factors such as age, hypertension, diabetes, coronary artery disease and congestive heart failure.⁵ The importance of AF in the setting of left ventricular dysfunction with our without preceding myocardial infarction is that it is both a precipitant and harbinger of increased morbidity and mortality.^6-8