{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:40:55Z","timestamp":1777945255258,"version":"3.51.4"},"reference-count":21,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100010731","name":"Faculty of Medicine, Chiang Mai University","doi-asserted-by":"publisher","award":["088\/2024"],"award-info":[{"award-number":["088\/2024"]}],"id":[{"id":"10.13039\/501100010731","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiological Reports"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    High\u2010intensity endurance exercise is linked to increased atrial fibrillation (AF) risk. P wave indices are established AF risk markers, but their role in ultramarathon athletes is unexplored. This study aimed to compare P wave indices between ultramarathon athletes and healthy controls. This cross\u2010sectional study enrolled 74 ultramarathon athletes and 38 age\u2010 and sex\u2010matched healthy volunteers (2:1 ratio). Athletes had completed \u22651 race of \u2265100\u2009km or \u226560\u2009km in the past year. Participants with AF, atrial flutter, cardiovascular diseases, or structural heart abnormalities were excluded. Resting 12\u2010lead ECGs evaluated P wave indices: maximum P wave duration, P wave dispersion, P wave terminal force in lead V1 (PTFV1), and P wave amplitude in lead II (PWAII). The cohort's mean age was 44.8\u2009\u00b1\u20098.2\u2009years, 70% male. Ultramarathon athletes had significantly higher maximum P wave duration (114.24\u2009\u00b1\u20097.95\u2009ms vs. 105.76\u2009\u00b1\u20097.15\u2009ms,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), P wave dispersion (18.77\u2009\u00b1\u20095.75\u2009ms vs. 7.87\u2009\u00b1\u20092.51\u2009ms,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), PTFV1 (5795.66\u2009\u00b1\u20093212.27\u2009\u03bcV\u00b7ms vs. 2399.17\u2009\u00b1\u20091140.19\u2009\u03bcV\u00b7ms,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and PWAII (0.16\u2009\u00b1\u20090.05\u2009mV vs. 0.12\u2009\u00b1\u20090.04\u2009mV). Abnormal P wave duration (&gt;120\u2009ms) and PTFV1 (\u22654000\u2009\u03bcV\u00b7ms) were significantly more prevalent in ultramarathon athletes (25.7% vs. 5.3%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.010; 63.5% vs. 5.3%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Similar findings were observed across genders. Ultramarathon runners demonstrate significant atrial electrical remodeling, as evidenced by abnormal P wave indices, may have potential relevance to arrhythmia risk. Further longitudinal studies are warranted to assess clinical outcomes.\n                  <\/jats:p>","DOI":"10.14814\/phy2.70766","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:29:22Z","timestamp":1771309762000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of P wave indices between ultramarathon athletes and general population"],"prefix":"10.14814","volume":"14","author":[{"given":"Narawudt","family":"Prasertwitayakij","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pongsatorn","family":"Tungsuk","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sirianong","family":"Namwongprom","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teerapat","family":"Nantsupawat","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siriluck","family":"Gunaparn","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3986-1951","authenticated-orcid":false,"given":"Arintaya","family":"Phrommintikul","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2418-329X","authenticated-orcid":false,"given":"Wanwarang","family":"Wongcharoen","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsem-2024-002379"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.4022\/jafib.1724"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.4022\/jafib.1657"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000659"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv216"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11030528"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autneu.2019.01.004"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2017.03.019"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.01.091"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2016.173"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.191097"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2025.02.020"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.07.014"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.037615"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13023"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eun289"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.785626"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.04.026"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/anec.12751"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad170"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-014-1341-6"}],"container-title":["Physiological 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