Meta‐Analysis of the Association Between Left‐Ventricular Late Gadolinium Enhancement on Cardiac MRI and Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

ABSTRACT Purpose Atrial fibrillation (AF) is a common complication in individuals with hypertrophic cardiomyopathy (HCM), associated closely with myocardial fibrosis. Late gadolinium enhancement (LGE) detected by cardiac magnetic resonance (CMR) imaging is a marker of myocardial fibrosis and may indicate an increased risk of AF. This meta‐analysis was performed to investigate the relationship between left ventricular (LV)‐LGE and the occurrence of AF in patients with HCM. Methods A comprehensive search of the PubMed, Embase, and Web of Science databases was conducted to identify observational studies in which the prevalence or incidence of AF in patients with HCM with and without LV‐LGE was compared. Random‐effects models were employed to calculate pooled odds ratios (ORs) and mean differences (MDs), accounting for potential heterogeneity across studies. Results Fourteen reports of 15 observational studies performed with 4 947 patients with HCM were included. The pooled results revealed that CMR‐detected LV‐LGE was associated with a significantly greater risk of AF (OR, 1.97; 95% confidence interval [CI] 1.41–2.75; p < 0.001, I 2 = 60%). Subgroup analyses yielded consistent results across study designs, patient ages, sex distributions, analytical models, and study quality scores. Based on data from six studies in which it was reported, the extent of LV‐LGE was greater in patients with AF than in those without AF (MD, 2.83%; 95% CI, 0.69–4.97; p = 0.01, I 2 = 66%). Conclusions CMR‐detected LV‐LGE is associated with a heightened AF risk in patients with HCM. Trial Registration CRD42024621359