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  Enhanced External Counterpulsation (EECP)

What is EECP?

A treatment for patients with chronic angina or patients who have had multiple bypasses or angioplasty procedures, Enhanced External Counterpulsation (EECP) was originally theorized in the 1950s at Harvard as a way to improve blood flow to the heart. In the last 50 years, EECP has moved from a theory to a beneficial medical procedure. During the 1960s, other researchers at Harvard developed the first hydraulic device for
external counterpulsation. In the early 70s, at a time when invasive cardiac procedures became more popular in the United States, a group of researchers from China improved on the original theories and devices. Then, during the 1980s, the Chinese research group collaborated with researchers from the State University of New York, Stony Brook to refine the external counterpulsation device.

Studies that have been conducted since the late 80s and early 90s have reported that EECP reduces frequency and intensity of angina attacks, allows for a greater tolerance for exercise, may reduce antianginal medication use, and, most important, improves quality of life. Recent studies have also shown that the benefits may last long after the treatment is completed, and that some patients can remain symptom free for years. While not considered as the first therapy to be administered to patients, EECP has become the treatment of choice for patients who have undergone one or more bypass
procedures or have seen no improvement with the use of antianginal medications. EECP is an FDA-approved, non-invasive, outpatient treatment for myriad cardiovascular conditions including congestive heart failure and chronic angina. EECP is recommended for patients who may have exhausted other treatment methods, such as bypass surgery, angioplasty, or antianginal medications. EECP works by helping the blood flow bypass blocked or partially blocked arteries by rerouting the blood through nearby artery branches (called collateral circulation).

Who is eligible?

EECP is not considered a first line treatment. Typically, physicians consider people with chronic chest pain (angina) that has not been helped by medication, people who have other existing diseases or conditions that would make them poor candidates for invasive procedures (such as surgery), or people who have continued to have heart problems despite multiple bypass surgeries or angioplasty procedures.
    EECP is not recommended for patients with:
  • uncontrolled heart failure;
  • blood pressure higher than 180/110;
  • a heart rate higher than 120 beats per minute;
  • lung disease; and
  • a history of phlebitis (vein inflammation)
Pregnant women are advised not to undergo EECP.

Risk Factors

EECP is risk free; no adverse events have been reported during or following the procedure. Chafing and skin irritation have been known to occur because of the movements of the cuffs; therefore, physicians recommend that the patient wear tight-fitting pants such as bicycle shorts or tight-fitting athletic pants.

What to Expect

EECP is conducted in a series of 35 one-hour sessions. Typically only a single one-hour session is performed in a day; however, in some cases, two sessions can be conducted in one day providing the patient rests between the sessions.

When the patient arrives for the procedure, he or she is asked to lie on a bed in the treatment room. Electrocardiograph (ECG) electrodes are fixed to the
patient's chest to monitor the heartbeat, and a plethysmograph (finger sensor) is attached to a patient's finger. A series of pressure cuffs (similar to blood pressure cuffs) are wrapped around the patient's calves, lower thighs, and upper thighs. Synchronized to the heartbeat by the ECG, the cuffs are inflated and deflated. The rapid inflation and deflation of the cuffs are modulated by the cardiac cycle (heartbeats). As the cuffs are inflated, the patient will feel a slight squeeze (or hug), similar to the feeling experienced for a blood pressure cuff. The cuffs are inflated one at a time in a sequence from low (calves) to high (upper thighs), and the pressure moves the blood from the lower limbs toward the heart. Blood is delivered to the heart at the precise moment it is relaxing and blood flows through the vessels at its peak. Just before the heart pumps, the pressure in the cuffs is released and all of the cuffs are deflated at one time.

Post-Treatment Guidelines

EECP requires no recovery period. Following the first few treatment sessions, however, some patients report feeling fatigued. After a few sessions, the feelings of fatigue decrease as the patient becomes more tolerant of the procedure.

Long-Term Prognosis

The results of a five-year follow-up study published in the journal Clinical Cardiology in 2000, reported that out of 33 patients who had undergone the EECP procedure, 21 (64%) were still alive five years later without any major cardiovascular events or the need for bypass surgery or balloon angioplasty.
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