External Counterpulsation ECP


External Counterpulsation Guide

External Counterpulsation is a medical procedure performed on patients with angina, heart failure, or cardiomyopathy. Here’s our guide to external counterpulsation.

What is External Counterpulsation?

External Counterpulsation, also known as ECP or EECP (for “Enhanced” External Counterpulsation), is a procedure used to improve the functional capacity and quality of life of patient with conditions like:

— Heart Failure
— Angina
— Cardiomyopathy

ECP has been shown to reduce symptoms of ischemia and relieve angina in various studies.

The goal of external counterpulsation is to prevent the heart from working so hard. By reducing the workload of the heart, patients can enjoy various health benefits.

The procedure was first developed in the 1960s and has been extensively studied in over 190 published papers to-date.

How Does External Counterpulsation Work?

During external counterpulsation treatment, patients have pneumatic cuffs strapped to their legs. They’re connected to a telemetry system that monitors heart rate and rhythm.

The specific procedure varies between health care providers. However, the most common procedure involves placing three cuffs on each leg (one on the calf, one on the thigh, and one on the upper thigh or buttocks).

Based on the patient’s electrocardiogram, the cuffs will inflate or deflate. Medically speaking, the cuffs will inflate at the beginning of diastole (the part of the cardiac cycle where the heart refills itself with blood) and deflate at the beginning of systole (the part of the cardiac cycle when the ventricles contract).

The cuffs inflate sequentially, with the calf cuffs inflating first before moving up to the lower thigh and upper thigh cuffs.

The pressure within each cuff is controlled by a pressure monitor. Typically, cuffs are inflated to 200 millimeters of mercury (mmHg).

How Does External Counterpulsation Improve Heart Health?

The goal of external counterpulsation is to decrease the afterload (where the heart pumps against the flow) and increase the preload.

Together, this leads to increased cardiac output.

At the same time, ECP increases blood flow to the coronary arteries.

There are also other theories on why ECP works. One theory is that ECP exposes the coronary arteries to stress. This stress leads to a surge in the production of growth factors that lead to angiogenesis (the growth of new blood vessels from existing blood vessels).

In that sense, ECP is a rehabilitation process that involves using a mechanical external device to kickstart your body’s natural processes.

Benefits of External Counterpulsation

Pushing oxygen and nutrient-rich blood through the body leads to various health benefits. Some of the benefits of ECP include:

— Revive tissue in parts of the heart and body that have been restricted due to poor blood flow

— Improvement in structure and strength of blood vessels

— Reduced workload on the heart

Reduced symptoms of heart problem symptoms, including reduced chest pain, shortness of breath, chronic fatigue (tiredness), and exercise tolerance

These health benefits vary greatly between patients.

Who Should Undergo External Counterpulsation?

Wikipedia reports that External Counterpulsation is particularly popular among the following groups of people:

— Angina patients who are not relieved by medicine

— Patients who don’t want to have bypass surgery

— Patients who are contraindicated for bypass or angioplasty due to kidney failure, liver failure, diabetes, very old age, and other medical conditions

Cleveland Clinic, on the other hand, reports that you may be a candidate for enhanced external counterpulsation (EECP) if you:

— Have chronic stable angina

— Are not receiving adequate relief from angina by taking nitrates

— Don’t qualify as a candidate for invasive procedures like bypass surgery, angioplasty, or stenting

What to Expect During your ECP Procedure

ECP is performed in an outpatient setting and is non-invasive. During treatment, you can expect the following:

— You’ll lie down on a padded table in the treatment room.

— The physician will apply three electrodes to the skin on your chest and connect you to an electrocardiogram (ECG) machine. The ECG monitor will display the rhythm of you heart throughout the procedure while also monitoring blood pressure.

— The physician will wrap a set of padded fabric cuffs around your calves, thighs, and buttocks. Those cuffs are connected to air hoses that are timed to deflate and inflate in time with your body’s natural rhythms.

— Once the procedure begins, you’ll feel a sensation of a strong “hug” that moves upward from your calves through your thighs and to your buttocks.

If you’re accepted for EECP therapy, you’ll need to undergo a total of 35 hours of treatment. These treatments are administered for 1 to 2 hours a day, five days a week, for 7 weeks.


When you research external counterpulsation online, you’ll find the terms ECP and EECP used interchangeably. What’s the difference between the two procedures?

EECP is a registered trademark procedure that uses equipment made by Vasomedical Inc., which is a Westbury New York-based medical equipment manufacturer. Only Vasomedical may use the trademarked name for EECP.

External counterpulsation (ECP) is the generic name for the circulatory assist technique used by EECP equipment. ECP was first introduced by three doctors in the 1960s who used a hydraulic system with a single bladder to reduce heart workload by pushing blood through the lower extremities.

EECP.com, which is the official website for Vasomedical Inc.’s procedure, explains more about the differences between EECP and ECP (albeit in a biased way) and the benefits of using EECP from a trusted provider.

Scientific Evidence for ECP

ECP and EECP are backed by scientific evidence.

The most important study on EECP was published in the American Journal of Cardiology in January 2006 and involved over 350 patients.

That study lasted two years. Here are some of the important results from the study:

— The study lasted included 363 patients who had refractory angina and LV ejection fraction. Most of these patients reported their quality of life as “poor”.

— After completion of EECP treatment, there was a significant decrease in the severity of angina class. 72% improved from severe angina to no angina or mild angina.

— 52% of patients were able to discontinue their use of nitroglycerin.

— Quality of life “improved substantially”.

— In a 2 year follow-up, this decrease in angina was maintained in 55% of patients. The 2 years survival rate was 83% and the major adverse cardiovascular event-free survival rate was 70%.

— Throughout this two year period, 43% had no reported cardiac hospitalization while 81% had no reported congestive heart failure events. Repeat EECP was performed in 20% of these patients.

Researchers concluded this study by stating the following:

“In conclusion, for patients who have high-risk LV dysfunction, EECP offers an effective, durable therapeutic approach for refractory angina. Decreased angina and improvement in quality of life were maintained at 2 years, with modest repeat EECP and low major cardiovascular event rates.”

Ultimately, this is one of over 190 published studies that reinforce the benefits of EECP. EECP.com has more information about clinical and scientific evidence ECP and EECP here.

How to Undergo ECP

ECP is now available at clinics across America.

One of the best ways to find ECP or EECP in your area is to use EECP.com, where you can enter your zip code to find a clinic offering EECP in your area.

EECP is a procedure exclusively offered by Vasomedical, Inc. – so the clinic with which you work will have to have a licensing agreement with Vasomedical. However, you can find some clinics that offer ECP, which is the generic form of the procedure.

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