BACKGROUND: Our previous review reported great variability in the incidence and prevalence of atrial fibrillation (AF) in non-Western cohorts, especially from Asian countries; in recent years, epidemiologic studies on AF have been increasingly reported from Asia. METHODS: The goal of this updated systematic review was to present the current knowledge base of AF epidemiology in Asian countries since our previous review. We also explored AF incidence and the risk of stroke in AF by using a meta-analysis, with I-2 testing the heterogeneity. Third, "real-world" antithrombotic drug use for ischemic stroke (IS) prevention associated with AF was studied. RESULTS: A total of 58 articles from eight countries in Asia were included in the analysis. The summary annual incidence of AF was 5.38 (95% CI, 4.53-6.24; I-2 = 99.5%; n = 10) per 1,000 person-years, and the IS annual risk in AF was 3.0% (1.60%-4.95%; I-2 = 99.8%; n = 8) when meta-analysis was performed on hospital-and community-based studies. Hospital-and community-based AF prevalence ranged from 0.37% to 3.56% and 2.8% to 15.8%, respectively. IS prevalence in AF ranged from 1.9% to 6.0% and 0.36% to 28.3% in community-and hospital-based studies. Warfarin use in Chinese subjects is relatively low (1.0%-4.1%) compared with Japanese subjects (49.1%-70.0%) in community-based studies. The rate of warfarin use was < 50% in hospital-based studies. CONCLUSIONS: The incidence and prevalence of AF have increased in recent years, although great variability still exists in Asian countries. Variability in annual IS risk in patients with AF was apparent between hospital-and community-based studies. However, the rate of warfarin use was < 50% in hospital studies from Asian countries.