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

Waśkiewicz Z. Bezuglov E. Talibov O. Gajda R. Mukhambetov Z. Azerbaev D. Bondarev S.
July 2025 Multidisciplinary Digital Publishing Institute (MDPI)

Journal of Cardiovascular Development and Disease
2025 #12 Issue 7

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.

atrial fibrillation , cardiac remodeling , endurance athletes , marathon , ultramarathon

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Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education, Katowice, 40-065, Poland
Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University, Moscow, 119991, Russian Federation
Department of Internal Medicine, Clinical Pharmacology and Emergency Medicine, Moscow State University of Medicine and Dentistry, Moscow, 127473, Russian Federation
Center for Sports Cardiology, Gajda-Med Medical Center, Pułtusk, 06-100, Poland
Department of Kinesiology and Health Prevention, Jan Dlugosz University in Częstochowa, Częstochowa, 42-200, Poland
Department of Sport Education and Coaching, Academy of Physical Education and Mass Sport, Astana, 010000, Kazakhstan
Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, 35122, Italy

Institute of Sport Sciences
Department of Sports Medicine and Medical Rehabilitation
Department of Internal Medicine
Center for Sports Cardiology
Department of Kinesiology and Health Prevention
Department of Sport Education and Coaching
Department of Cardiac

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