Abstract: Atrial fibrillation (AF) is the most common persistent arrhythmia, and its pathogenesis mainly involves atrial electrical remodeling and structural remodeling. Existing methods of diagnosis and treatment have certain limitations. Exosomes are a special type of extracellular vesicles that can deliver bioactive molecules such as non-coding RNA (ncRNA), messenger RNA and proteins to the recipient cells to perform a variety of biological functions. Current studies have shown that exosomal ncRNA plays an important role in the mechanisms of atrial electrical remodeling and structural remodeling. Exosomal ncRNA has the potential to become a biomarker of AF and provide a new strategy for the treatment of AF. This article reviews the research progress of exosomal ncRNA in the pathogenesis, diagnosis and treatment of AF, and provides references and new ideas for its clinical transformation.