Enhanced External Counterpulsation – EECP

Enhanced external counterpulsation (EECP) is a mechanical form of treatment for angina. While several clinical studies appear to show that this treatment can be helpful in reducing symptoms of angina in patients with coronary artery disease (CAD), EECP has yet to be accepted by most cardiologists, and has not entered the mainstream of cardiology practice.

What is EECP?

EECP is a mechanical procedure in which long inflatable cuffs (like blood pressure cuffs) are wrapped around both of the patient’s legs.

While the patient lies on a bed, the leg cuffs are inflated and deflated synchronously with each heartbeat. The inflation and deflation are controlled by a computer, which uses the patient’s ECG to trigger inflation early in diastole (when the heart relaxes and is filled with blood), and deflation just as systole (heart contraction) begins. The inflation of the cuffs occurs sequentially, from the lower part of the legs to the upper, so that the blood in the legs is “milked” upwards, toward the heart.

EECP has at least two potentially beneficial actions on the heart. First, the milking action of the leg cuffs increases the blood flow to the coronary arteries during diastole.

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(The coronary arteries, unlike other arteries in the body, receive their blood flow in between heartbeats, instead of during each heartbeat.) Second, by its deflating action just as the heart begins to beat, EECP creates something like a sudden vacuum in the arteries, which reduces the work the heart muscle has to perform in pumping blood. It is also speculated that EECP may help reduce endothelial dysfunction.

EECP is administered as a series of outpatient treatments. Patients receive 5 one-hour sessions per week, for 7 weeks (for a total of 35 sessions). The 35 one-hour sessions are aimed at provoking long lasting beneficial changes in the circulatory system.

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