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Background: Cardiovascular involvement is a significant cause of death in COVID pneumonia. Early electrocardiographic changes may predict cardiovascular involvement and predict mortality in COVID pneumonia patients. Methods: A total of 250 consecutive patients with COVID-19 pneumonia admitted to the emergency were studied for electrocardiographic abnormalities and their relation to mortality. Results: Most patients required supplemental oxygen to maintain optimal saturation. A total of 72% showed ECG abnormalities, and the overall cohort had a mortality of 50%. New-onset atrial fibrillation, left bundle branch block or right bundle branch pattern, and ventricular premature complexes were associated with high mortality. Sinus tachycardia and atrial fibrillation were the most common arrhythmia and were significantly associated with mortality. Conclusions: New-onset atrial fibrillation, intraventricular conduction defects, and sinus tachycardia are associated with increased mortality in COVID pneumonia patients.