There have been increasing research efforts in recent years to evaluate the role of various dietary supplements, such as antioxidant vitamins, L-arginine, glucan, isoflavones, soy estrogens, omega-3 fatty acids, etc., in cardiovascular health. Although there is not adequate evidence of the beneficial effects of many nutriceuticals on cardiac function, in the case of omega-3 fatty acids, the evidence has been more convincing. Fish oil has historically been thought to be good for cardiovascular health; however, data have revealed a stronger cardioprotective role of fish oil in recent years. Fish oil and specifically omega-3 fatty acids exhibit cardioprotective effects by mainly improving mortality in coronary artery disease patients. This is achieved through multiple mechanisms with the antiarrhythmic mechanism being the most prominent one. Effects on sodium and calcium channels and heart rate variability are well-accepted mechanisms of how omega-3 fatty acids exercise antiarrhythmic effects. In this review we will address some of the basic science and clinical data regarding omega-3 fatty acids and their direct cardiovascular protective role with details on the proposed mechanisms of this role. We will also address fish pollutants and their significance and finally, the current recommendations about using these fatty acids for cardiovascular protection.