What is Enhanced External Counterpulsation (EECP)?

Enhanced external counterpulsation (EECP) is a noninvasive procedure in which a set of inflatable cuffs (much like blood pressure cuffs) mechanically compress the blood vessels in the patient’s lower limbs to increase blood flow in the coronary arteries of the heart. The blood pressure cuffs are wrapped around the patient’s calves, thighs, and buttocks. Computer technology, electrocardiography , and blood pressure monitors enable the accurate timing of gentle but firm inflation and deflation of the pressure cuffs with the patient’s heartbeat and blood pressure.

EECP is performed to restore blood flow to the heart and to relieve chest pain (angina) and ischemia. The goals of the procedure are to relieve symptoms of coronary artery disease, enable the patient to resume a normal lifestyle, and lower the risk of a heart attack or other heart problems. EECP may encourage blood vessels to open small channels (called collaterals) to eventually bypass blocked vessels and improve blood flow to the heart.

Why EECP is a substitute for heart surgery?
EECP is used to treat patients with chronic stable angina, coronary artery disease, or high blood pressure. Most recently, the Food and Drug Administration (FDA) has approved EECP for the treatment of congestive heart failure. The treatment may be appropriate for patients who are not eligible for such non-surgical interventional procedures as balloon angioplasty , stent placement, rotoblation, atherectomy, or brachytherapy. It may also be used for patients who do not qualify for such surgical treatment as coronary artery bypass graft surgery.

EECP is not the first-line treatment for angina. Rather, it is reserved for patients who have not achieved good results from medication or interventional management of their symptoms. EECP may benefit patients with such other medical conditions as erectile dysfunction, kidney disease, eye disease, diabetic neuropathy, and other circulatory disorders. More research is needed to evaluate the outcomes of EECP for these patients.

The benefits of EECP are comparable to the results of angioplasty and coronary artery bypass graft surgery: 80% of patients experience significant improvement after EECP treatment. The largest research study on EECP indicates that after receiving treatment, patients used less medication, had fewer angina attacks with less severe symptoms, and increased their capacity to exercise without experiencing symptoms. EECP improves the patient’s sense of well-being and overall quality of life; and in some cases, prolongs the patient’s life. Benefits five years after EECP treatment are comparable to surgical outcomes. EECP does not prevent coronary artery disease from recurring; therefore, lifestyle changes are strongly recommended and medications are prescribed to reduce the risk of recurrent disease.

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