Rilonacept for Recurrent Postcardiac Injury Syndrome Pericarditis in a Young Hockey Player: When to Return to Exercise.

BACKGROUND

Postcardiac injury syndrome (PCIS) pericarditis is a common complication following cardiac surgery. Exercise counseling is critical for recovery, but guidelines for return-to-activity are often generalized.

CASE SUMMARY: A 35-year-old male experienced a ventricular tachycardia arrest due to a left anterior descending infarct while playing hockey. He underwent coronary artery bypass grafting and developed acute pericarditis due to PCIS. Despite colchicine and prednisone, he had 3 recurrences of pericarditis. Rilonacept (an interleukin-1 blocker) was started in October 2023. After 6 months, his condition improved, and exercise was gradually reintroduced with heart rate limits, initially <130 beats/min, later increasing to 145 to 150 beats/min.

DISCUSSION: Exercise restriction is essential in acute and recurrent pericarditis until symptoms resolve and inflammatory markers normalize. Limited data exist regarding exercise while on interleukin-1 blockers such as rilonacept, and shared decision-making is critical.

TAKE-HOME MESSAGE: Gradual reintroduction of exercise based on clinical stability and inflammatory markers is key in managing recurrent pericarditis due to PCIS after coronary artery bypass grafting.