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Review
. 2025 Jul 7;12(7):260.
doi: 10.3390/jcdd12070260.

Divergent Cardiac Adaptations in Endurance Sport: Atrial Fibrillation Markers in Marathon Versus Ultramarathon Athletes

Zbigniew Waśkiewicz  1 , Eduard Bezuglov  2 , Oleg Talibov  3 , Robert Gajda  4   5 , Zhassyn Mukhambetov  6 , Daulet Azerbaev  6 , Sergei Bondarev  7
Affiliations
Review

Divergent Cardiac Adaptations in Endurance Sport: Atrial Fibrillation Markers in Marathon Versus Ultramarathon Athletes

Zbigniew Waśkiewicz et al. J Cardiovasc Dev Dis. .

Abstract

Endurance training induces significant cardiac remodeling, with evidence suggesting that prolonged high-intensity exercise may increase the risk of atrial fibrillation (AF). However, physiological responses differ by event type. This review compares AF-related markers in marathon and ultramarathon runners, focusing on structural adaptations, inflammatory and endothelial biomarkers, and the incidence of arrhythmias. A systematic analysis of 29 studies revealed consistent left atrial (LA) enlargement in marathon runners linked to elevated AF risk and fibrosis markers such as Galectin-3 and PIIINP. In contrast, ultramarathon runners exhibited right atrial (RA) dilation and increased systemic inflammation, as indicated by elevated high-sensitivity C-reactive protein (hs-CRP) and soluble E-selectin levels. AF incidence in marathoners ranged from 0.43 per 100 person-years to 4.4%, while direct AF incidence data remain unavailable for ultramarathon populations, highlighting a critical evidence gap. These findings suggest distinct remodeling patterns and pathophysiological profiles between endurance disciplines, with implications for athlete screening and cardiovascular risk stratification.

Keywords: atrial fibrillation; cardiac remodeling; endurance athletes; marathon; ultramarathon.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram description.
Figure 2
Figure 2
Heatmap summary of atrial fibrillation-related markers in marathon and ultramarathon runners. Effect levels represent the direction and consistency of changes across multiple studies: −1 = reduction, 0 = no change or not reported, 1 = modest increase (1 study), and 2 = consistent increase (≥2 studies). LA, left atrium; RA, right atrium; LV, left ventricle; RV, right ventricle; GLS, global longitudinal strain; FAC, fractional area change.
Figure 3
Figure 3
Forest plot of atrial fibrillation prevalence among endurance athletes based on three cohort studies [1,2,28].
See this image and copyright information in PMC

References

    1. Molina L., Mont L., Marrugat J., Berruezo A., Brugada J., Bruguera J., Rebato C., Elosúa R. Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: A follow-up study. Europace. 2008;10:618–623. doi: 10.1093/europace/eun071. - DOI - PubMed
    1. Wilhelm M., Roten L., Tanner H., Wilhelm I., Schmid J., Saner H. Gender differences of atrial and ventricular remodeling and autonomic tone in nonelite athletes. Am. J. Cardiol. 2011;108:1489–1495. doi: 10.1016/j.amjcard.2011.06.073. - DOI - PubMed
    1. Wilhelm M., Nuoffer J., Schmid J., Wilhelm I., Saner H. Comparison of pro-atrial natriuretic peptide and atrial remodeling in marathon versus non-marathon runners. Am. J. Cardiol. 2012;109:1498–1502. doi: 10.1016/j.amjcard.2011.11.039. - DOI - PubMed
    1. Fernández J.A., Ocaranza M.P., Herrera S., Vega J., Salinas M., Contreras-Briceño F., Llevaneras S., Jalil J.E., Yañez F., Godoy P., et al. Biomarcadores de fibrosis y función ventricular derecha en maratonistas con distinto grado de entrenamiento: Estudio en la maratón de Santiago. Rev. Chil. Cardiol. 2019;38:15–23. doi: 10.4067/S0718-85602019000100037. - DOI
    1. Gabrielli L., García L., Fernández R., Vega J., Ocaranza M., Contreras F., Salinas M., Chiong M., Jalil J., Munoz M., et al. Increased circulating levels of VCAM-1 correlate with left atrial remodeling in highly trained athletes. Eur. Heart J. 2019;40((Suppl. S1)):ehz745.0823. doi: 10.1093/eurheartj/ehz745.0823. - DOI

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