PURPOSE: To provide an overview of existing literature on the association between late gadolinium enhancement (LGE) cardiac MRI and low voltage areas (LVA) obtained with electroanatomic mapping (EAM) or histopathology when assessing atrial fibrosis.

MATERIALS AND METHODS: A systematic literature search was conducted in the PubMed, Embase, and Cochrane Library databases to identify all studies published until June 7, 2022, comparing LGE cardiac MRI to LVA EAM and/or histopathology for evaluation of atrial fibrosis. The study protocol was registered at PROSPERO (registration no. CRD42022338243). Two reviewers independently evaluated the studies for inclusion. Risk of bias and applicability for each included study were assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) criteria. Data regarding demographics, electrophysiology, LGE cardiac MRI, and study outcomes were extracted.

RESULTS: The search yielded 1048 total results, of which 22 studies were included. Nineteen of the 22 included studies reported a significant correlation between high signal intensity at LGE cardiac MRI and LVA EAM or histopathology. However, there was great heterogeneity between included studies regarding study design, patient samples, cardiac MRI performance and postprocessing, and EAM performance.

CONCLUSION: Current literature suggests a correlation between LGE cardiac MRI and LVA EAM or histopathology when evaluating atrial fibrosis but high heterogeneity between studies, demonstrating the need for uniform choices regarding cardiac MRI and EAM acquisition in future studies.Keywords: Cardiac, MR Imaging, Left Atrium Supplemental material is available for this article. © RSNA, 2022.