Atrial fibrillation (AF) is the most common arrhythmia and a major cardiovascular challenge due to its close association with increased morbidity and mortality. Although the incidence and prevalence of AF is slightly lower in developing countries than in developed countries, the AF associated risk of stroke is similar. Treatment of AF is far from satisfactory in developing countries, which may be due to limited health-care resources and different social and racial characteristics from western population. Chronic rate control is still the main treatment strategy of persistent AF because anti-arrhythmic drugs have only a modest long-term effect on maintenance of sinus rhythm, and no superior impact in terms of cardiovascular outcomes. With the development of ablation techniques and strategies of AF, more AF patients received catheter ablation although the benefit, complications, and high recurrence rate associated with AF ablation still remain under investigation. Improvement in antithrombotic therapy of AF has been observed although still less patients receive oral anticoagulants in developing countries than western countries. Novel treatment for prevention of thrombembolism, like new oral anticoagulants with different mechanisms of action, the percutaneous transcatheter closure of left atrial appendage, have recently been introduced in developing countries as an alternative option for prevention of AF associated stroke. More data are needed in regards to upstream therapy of AF in the future.