Key result
Marathons are linked to ~4% AF prevalence and LA enlargement, whereas ultramarathons feature RA remodeling.
Why the study?
Prolonged high-intensity endurance exercise induces cardiac remodeling with differing physiological responses by event type, but comparative data on AF-related markers in marathon versus ultramarathon runners are limited.
Does the type of endurance sport (marathon vs ultramarathon) differentially affect atrial fibrillation markers and cardiac remodeling in athletes?
Systematic Review
Does the type of endurance sport (marathon vs ultramarathon) differentially affect atrial fibrillation markers and cardiac remodeling in athletes?
Marathon and ultramarathon running induce distinct cardiac remodeling patterns, suggesting different pathophysiological profiles and cardiovascular risks between the two endurance disciplines.
Marathon versus ultramarathon runners may need sport-specific AF monitoring; extends remodeling hypotheses but leaves clinical impact open pending prospective data.
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.
No takes yet. Share an insight, caveat, or question.
Waśkiewicz et al. (2025) conducted a systematic review in Atrial fibrillation and cardiac remodeling. Marathon and ultramarathon running vs. Non-running controls or between endurance disciplines was evaluated on Pooled prevalence of atrial fibrillation among endurance athletes (95% CI 2.52-5.94). Marathon running is associated with left atrial enlargement and an elevated atrial fibrillation risk (pooled prevalence 4.23%), whereas ultramarathon running predominantly induces right atrial remodeling and systemic inflammation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: