External Counter Pulsation Treatment

What is ECP?
External Counter Pulsation (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 its starved areas. With more oxygen available, the heart can function
much more efficiently and therefore, reduce chest pain.
History of ECP Treatments
ECP treatment originated in China where it has been extensively used since the 1960s. 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.
Recommendations and contraindications for EECP therapy

Recommendations

Contraindications

patients with angina pectoris not

responding
to pharmacotherapy, limiting their activity in
order to avoid effects of the angina

arrhythmias disturbing the action of the

assisting apparatus

hemophilia

patients who do not want to undergo an

invasive operation of revascularization

thrombophlebitis

acute arterial obstruction of lower limbs

proven aortic aneurysm requiring surgical

intervention

pregnancy

decreased systolic function of left ventricle

EF < 35%

co-existence of diseases that increase

surgery associated risks (diabetes, renal
insufficiency, lung diseases)

moderate or acute aortic regurgitation

patients disqualified from invasive

revascularization

blood pressure exceeding 180 mmHg

patients with small-vessel disease

acute chronic obstructive pulmonary

disease (COPD)

elderly patients with a higher risk of

disorders or death as a result of
intervention with an invasive method

medical history of pulmonary

embolism

Benefits of ECP Treatment

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Increased oxygen supply for the heart

Decrease in chest pain
Improved EKG response to exercise
Decrease in Nitroglycerin use
Increase in energy
Increased exercise duration
Long term effects up to 2 years

Principle of external counter pulsation action

Schematic of enhanced external counter pulsation (EECP), showing sequential cuff inflation at
the onset of diastole to raise diastolic pressure, and of deflation just before cardiac systole to
lower systolic pressure.
The principle of EECP is simple: mechanically increase venous return to the heart and decrease cardiac
afterload. The procedure itself is similarly straightforward: 3 compressive cuffs are wrapped around each
leg and synchronized to inflate during cardiac diastole; a retrograde pulse wave is created that increases
venous return to the heart, thereby increasing coronary artery perfusion pressure; deflation of the cuffs at
the onset of cardiac systole creates negative pressure from the peripheral arterial system that decreases
cardiac afterload. The hemodynamic effect of EECP is similar to that of an intra-aortic balloon pump.
EECP can decrease oxygen consumption and enhance cardiac output by up to 25%. Patients usually
undergo 35 consecutive 1-hour sessions of EECP over 57 weeks.