External Counterpulsation Treatment

What is ECP?

External Counterpulsation (ECP) is performed as a non-invasive treatment to lower the number and intensity of angina episodes. Treatment is administered through three pairs of external inflatable cuffs that are applied around the lower legs, upper legs and buttocks These cuffs continuously inflate and deflate between the resting period of the heart beat and increase blood returned to the heart.

The basic principle of ECP treatment involves increasing the amount of blood returning to the heart, which helps supply more oxygen to it’s starved areas. With more oxygen available, the heart can function much more efficiently and therefore, reduce chest pain.

The standard EECP treatment protocol consists of one-hour session per day, five days a week, for seven consecutive weeks, for a total of 35 treatment sessions. A modified treatment protocol consists of two-hours per day, six days per week, for three weeks. Repeat EECP may be required in about 20% of patients, especially if they failed to complete the initial 35-hours of EECP therapy.

History of ECP Treatments


ECP treatment originated in China where it has been extensively used since the 1960’s. In the past 10 years it has been introduced to the United States, where there are currently around 1200 machines in operation. The idea for ECP, stemmed from the development of the intra aortic balloon pump (IABP). IABP resulted in increasing the amount of blood that can get pumped out of the heart by inflating a balloon in the aorta between each heart beat. Opening up the aorta allows more blood flow and therefore decreased how hard the heart has to work. This same theory is applied to ECP but is taken one step further. ECP Increases the amount of blood going back to the heart, providing more blood for the heart to work with. This also decreases how hard the heart has to work but on a much greater scale, especially for people with damaged heart tissue.

Who is Eligible for ECP Treatment?

Individuals are eligible for treatment if they have:

Had coronary artery bypass (CABG) or stents placed in the coronary arteries with ongoing angina.
Had no prior bypass or stenting but continue to suffer from angina