INTRODUCTION
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread globally causing COVID-19 since the first reported cases in Wuhan, China in December 2019 [1-3]. The majority with COVID-19 remain asymptomatic or with mild symptoms, however around 20 % will have severe symptoms with multiorgan failure triggered by cytokine storm [4]. Several recent studies have demonstrated the deleterious effects of COVID 19 on cardiovascular system comprising acute myocardial injury, myocarditis, cardiomyopathies, arrythmias, cardiogenic shock and cardiac arrest [5-8].
New onset atrial fibrillation (NOAF) is the commonest arrythmia seen in patients treated in intensive care unit (ICU) and is a sequelea of critical illness. The incidence of NOAF is reported between 20-46% amongst patients treated for sepsis in ICU with a strong association with mortality [9-12]. Inflammation per se is likely a trigger for initiation, maintainance and perpetuation of AF [13] and we hypothesised the incidence of NOAF will be higher in COVID-19 due to high inflammatory state secondary to cytokine release syndrome. In a study by Wang et al, arrythmia amongst COVID-19 were more common in ICU patients (44.4%) than the counterpart [14], however the nature of the arrythmias was not described. There is paucity in the emerging literatures with regard to the nature of common arrythmias attributed by COVID-19 in ICU and there is no literature so far reporting the frequency of NOAF in severe COVID-19. Therefore the purpose of our study is to explore the incidence and clinical characteristics of patients with NOAF in severe COVID-19 admitted to ICU and to evaluate its prognostic impact with respect to mortality.