Enhanced External Counterpulsation - Method

Method

While an individual is undergoing EECP, one has pneumatic cuffs on his legs and are connected to telemetry monitors that monitor their heart rate and rhythm. The most common type in use involves three cuffs placed on each leg (on the calves, the lower thighs, and the upper thighs (or buttock)). The cuffs are timed to inflate and deflate based on the individual's electrocardiogram. The cuffs should ideally inflate at the beginning of diastole and deflate at the beginning of systole. During the inflation portion of the cycle, the calf cuffs inflate first, then the lower thigh cuffs and finally the upper thigh cuffs. Inflation is controlled by a pressure monitor, and the cuffs are inflated to about 200 mmHg.

When timed correctly, this will decrease the afterload that the heart has to pump against, and increase the preload that fills the heart, increasing the cardiac output. In this way, EECP is similar to the intra-aortic balloon pump (IABP). Since it increases pressure in the aorta while the heart is relaxing (during diastole) EECP also increases blood flow into the coronary arteries, which also occurs during that phase.

EECP is a non-invasive, outpatient therapy. During treatment:

1. Patients lie down on a padded table in a treatment room
2. Three electrodes are applied to the skin of the chest and connected to an electrocardiograph (ECG) machine. The ECG will display the heart’s rhythm during treatment. Blood pressure is also monitored.
3. A set of cuffs is wrapped around the calves, thighs and buttocks. These cuffs attach to air hoses that connect to valves that inflate and deflate the cuffs. Patients experience a sensation of a strong "hug" moving upward from calves to thighs to buttocks during inflation followed by the rapid release of pressure on deflation. Inflation and deflation are electronically synchronized with the heartbeat and blood pressure using the ECG and blood pressure monitors.

The EECP treatment gently but firmly compresses the blood vessels in the lower limbs to increase blood flow to your heart. Each wave of pressure is electronically timed to the heartbeat, so that the increased blood flow is delivered to your heart at the precise moment it is relaxing. When the heart pumps again, pressure is released instantaneously. This lowers resistance in the blood vessels in the legs so that blood may be pumped more easily from your heart.

EECP may encourage blood vessels to open small channels that become extra branches. These channels or collaterals may eventually become "natural bypass" vessels to provide blood flow to heart muscle. This contributes to the relief of angina symptoms.

Patients who are accepted for treatment must undergo 35 hours of EECP therapy. Treatment is administered 1-2 hours a day, five days a week, for 7 weeks.

Published studies conducted at numerous medical centers have demonstrated benefits for most patients including:

• Less need for anti-anginal medication
• Decrease in symptoms of angina
• Increased ability to do activities without onset of symptoms
• Ability to return to enjoyable activities