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

patients who do not want to undergo an

invasive operation of revascularization

decreased systolic function of left ventricle EF < 35%

co-existence of diseases that increase

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

patients disqualified from invasive revascularization

patients with small-vessel disease

elderly patients with a higher risk of

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

arrhythmias disturbing the action of the assisting apparatus

hemophilia

thrombophlebitis

acute arterial obstruction of lower limbs

proven aortic aneurysm requiring surgical

intervention

pregnancy

moderate or acute aortic regurgitation

blood pressure exceeding 180 mmHg

acute chronic obstructive pulmonary disease (COPD)

medical history of pulmonary embolism

Benefits of ECP Treatment

o Increased oxygen supply for the heart o Decrease in chest pain o Improved EKG response to exercise o Decrease in Nitroglycerin use o Increase in energy o Increased exercise duration o 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.