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.