Atrial fibrillation is a common complication of heart surgery. Consequences for the patient who develops this dysrhythmia are many. It prolongs hospitalization, may induce hemodynamic compromise, and carries the risks of thromboembolism and stroke. Ongoing research for the past 30 years has identified several potential etiologies; therefore, management must be highly individualized. This article reviews current and past research on postoperative atrial fibrillation with a focus on individualized prevention and treatment of this problematic heart surgery complication.