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Background: Atrial fibrillation is one of the most common postoperative arrhythmias in noncardiac surgery. Postoperative atrial fibrillation is associated with increased morbidity and mortality, as well as prolonged hospital stays and subsequent drain on staff and resources. OBJECTIVES: We aimed to investigate preoperative and postoperative variables that are associated with atrial fibrillation after pancreaticoduodenectomy (PD). METHODS: We performed a retrospective chart review of 523 patients who underwent pancreaticoduodenectomy at our institution between 2000 and 2009; 384 resections were performed since 2005. We collected: patient demographics, history of cardiac disease, hypertension, hyperthyroidism or COPD, preoperative chemoradiotherapy, type of resection performed (pylorus-preserving pancreaticoduodenectomy or standard pancreaticoduodenectomy, with or without vascular resection) operative time, estimated blood loss and transfusions, tumor size and histology, lymph node status, postoperative hematocrit and leukocyte count and postoperative NSAID use. Data was analyzed with alpha = 0.05 using Fisher exact test for categorical variables and Mann-Whitney U or unpaired t test for continuous variables. RESULTS: Approximately 5% of the 248 patients included in the analysis experienced at least one episode of postoperative atrial fibrillation. Median age of patients with atrial fibrillation was 74 years, compared with 66 years in patients without atrial fibrillation (p = 0.0005). Patients with atrial fibrillation were more likely to have a history of cardiac disease (p = 0.0347) and to require treatment for an infection over the course of their hospitalization (p = 0.0199). Of note, 92% of the patients with atrial fibrillation suffered from delayed gastric emptying (DGE), defined as failure to tolerate a regular diet by the seventh postoperative day, compared to 46% of patients without atrial fibrillation (p = 0.0008). This association held true when controlling for age. A possible explanation linking postoperative atrial fibrillation and delayed gastric emptying could be intraoperative injury to a shared pathway of vagal innervation; others have noted a similar phenomenon, also attributed to vagal injury, of delayed gastric emptying after radiofrequency ablation of atrial fibrillation. Another possible explanation would be perioperative changes in fluid balance which could result in both bowel edema and volume overload. CONCLUSIONS: Age and a prior history of cardiac disease are risk factors for postoperative atrial fibrillation. Patients with postoperative atrial fibrillation are more likely to experience delayed gastric emptying.