Atrial fibrillation (AF) is the most common arrhythmia worldwide and has a significant impact on human health and substantial costs. Currently, there is a lack of accurate biomarkers for the diagnosis and prognosis of AF. Moreover, the long-term efficacy of the catheter ablation in the AF is unsatisfactory. Therefore, it is necessary to explore new biomarkers and treatment strategies for the mechanism-based AF. Exosomes are nano-sized biovesicles released by nearly all types of cells. Since the AF would be linked to the changes of the atrial cells and their microenvironment, and the AF would strictly influence the exosomal non-coding RNAs (exo-ncRNAs) expression, which makes them as attractive diagnostic and prognostic biomarkers for the AF. Simultaneously, the exo-ncRNAs have been found to play an important role in the mechanisms of the AF and have potential therapeutic prospects. Although the role of the exo-ncRNAs in the AF is being actively investigated, the evidence is still limited. Furthermore, there is a lack of consensus regarding the most appropriate approach for exosome isolation and characterization. In this article, we reviewed the new methodologies available for exosomes biogenesis, isolation, and characterization, and then discussed the mechanism of the AF and various levels and types of exosomes relevant to the AF, with the special emphasis on the exo-ncRNAs in the diagnosis, prognosis, and treatment of the mechanism-based AF.

心房颤动（AF）是世界范围内最常见的心律失常，对人类健康产生重大影响并造成巨大损失。目前，缺乏准确的生物标志物用于 AF 的诊断和预后。此外，导管消融治疗房颤的长期疗效并不令人满意。因此，有必要针对机制性房颤探索新的生物标志物和治疗策略。外泌体是几乎所有类型的细胞释放的纳米大小的生物囊泡。由于房颤与心房细胞及其微环境的变化有关，并且房颤会严格影响外泌体非编码RNA（exo-ncRNA）的表达，这使得它们成为有吸引力的房颤诊断和预后生物标志物。同时，人们发现exo-ncRNA在AF机制中发挥着重要作用，具有潜在的治疗前景。尽管外切 ncRNA 在 AF 中的作用正在积极研究，但证据仍然有限。此外，对于外泌体分离和表征的最合适方法缺乏共识。在本文中，我们回顾了可用于外泌体生物发生、分离和表征的新方法，然后讨论了 AF 的机制以及与 AF 相关的各种水平和类型的外泌体，特别重点讨论了 AF 中的 exo-ncRNA。基于机制的 AF 的诊断、预后和治疗。