EECP therapy:
A surgery free way to boost your heart's vitality.
By employing compression cuffs on the legs, EECP therapy enhances blood flow to the heart, alleviating symptoms and contributing to an improved quality of life. This safe and effective approach stands as an alternative to invasive procedures like angioplasty and bypass surgery, often serving as a complementary treatment alongside medication and lifestyle adjustments.
WHAT ARE THE EFFECTS OF EECP?
Research indicates that EECP therapy not only ameliorates the quality of life and alleviates symptoms, including chest pain, shortness of breath, and fatigue for up to three years following treatment, but also enhances cardiovascular function and reduces the necessity for hospitalization. In essence, EECP therapy offers a non-invasive and valuable solution for those grappling with angina and heart failure, fostering improved cardiac health and overall well-being.
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HOW IT WORKS?
EECP therapy enhances cardiac function by optimizing blood and oxygen supply to the heart muscle, reducing the heart's workload through sequential cuff inflation from the calves to the thighs and buttocks during the heart's resting phase. Just before the subsequent heartbeat, all cuffs simultaneously deflate, allowing blood to naturally divert away from arteries with significant plaque and favoring healthy, unobstructed vessels, ultimately forming lasting pathways for blood to reach the heart, resembling a "natural bypass."
Learn how EECP works with Buena Park Heart Center Founder & Medical Director Joe Caceres, M.D. FAHA, FAAC
This is a brief step-by-step explanation of the EECP therapy procedure
WHAT TO EXPECT?
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The EECP patient lies on a comfortable bed with a series of pneumatic cuffs (similar to BP cuffs) wrapped around the calves, thighs, and buttocks.
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Three electrodes are placed on the chest to monitor the heartbeats.
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The cuffs will inflate and deflate in time with the patient’s heartbeats.
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Cuff inflation occurs after each heartbeat—during diastole—squeezing the lower extremities and pushing the blood toward the heart. This increases the blood flow to the coronary arteries that provide much-needed oxygen and nourishment to the heart muscle.
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Rapid cuff deflation occurs before the next heartbeat. This creates a void in the blood vessels of the lower extremities. This decreases the effort exerted by the heart when it contracts during systole.
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Blood pressure changes are monitored by a sensor placed on one of the fingers.
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Vital signs are obtained before and after each treatment.
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The EECP therapist remains nearby to facilitate effective therapy and ensure patient comfort.
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Coronary artery disease (CAD) is a condition characterized by chronic inflammation. The current treatment options for CAD include invasive procedures like percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). However, these procedures only aim to relieve the symptoms of the condition and do not offer a cure or prevent heart attacks. An effective, non-invasive alternative to these procedures is EECP.
COMPARISON OF TREATMENTS
During EECP, the blood flowing to your heart will naturally bypass arteries with significant plaque and instead enter healthy, non-diseased blood vessels, circumnavigating blockages. In time, these new pathways are reinforced and become lasting routes for blood to reach your heart beyond the blockages. This is why EECP is often referred to as a “natural bypass.”
EECP: A NATURAL BYPASS
This is a brief step-by-step explanation of the EECP therapy procedure
WHAT TO EXPECT?
EECP candidates include patients with angina pectoris responding inadequately to anti-ischemic agents and coronary revascularization, who are inoperable or at high risk for operative complications or postoperative failure, who are poor candidates for PCI or CABG or continue to have disabling angina despite revascularization.
WHO IS A CANDIDATE FOR EECP?
Yes. The majority of our patients on EECP therapy have already had coronary angioplasty with stents (PCI) and/or CABG surgery. These patients received EECP therapy because of recurrent angina pectoris or similar symptoms despite optimal medical therapy and/or revascularization.
I have already had bypass surgery/angioplasty/stents. Can I still have EECP ?
How long do the clinical effects of EECP last?
The clinical benefits of EECP extend beyond the time period of any acute hemodynamic beneficial effects. For example, the patients treated with EECP in the Multicenter Study of Enhanced External Counterpulsation reported a reduction in angina episodes and a decrease in nitrate use beyond the duration of therapy.
It is not fully understood why, after the EECP therapy is completed, patients remain improved, and the clinical benefits of the treatment persist for several years.
How much pressure is applied during inflation?
The pressure applied to the pneumatic cuffs during sequential inflation—from calves to thighs to buttocks—is 4-6 pounds per square inch (psi), which is the equivalent to 206 to 360 mmHg. This produces a light squeezing sensation against the legs, similar to a massage.
Uncontrolled atrial fibrillation, atrial flutter, and frequent PVCs may interfere with the triggering of the EECP system. The average beats should be of 50-100/min. However, if the heart rate is controlled and no faster than 100 bpm, atrial fibrillation will not interfere with EECP.
Patients with frequent and irregular heartbeats with high heart rate (HR) >100 or low HR <50 should delay EECP until rate control has been achieved.
Can a patient with atrial fibrillation have EECP therapy?
Can a patient with varicose veins have EECP?
Yes. Varicose veins do not preclude individuals from receiving EECP. We often use extra padding in patients with varicose veins to ensure maximum comfort. If a diagnosis of deep vein thrombosis is entertained, however, a venous US Doppler study of the lower extremities should be performed in advance of EECP therapy.
Can a patient with peripheral artery disease have EECP?
Yes. EECP improves blood flow throughout the entire body, including the lower extremities. In our experience, patients with this condition—if not severe—may require more than 35 EECP sessions to obtain the full benefit of the therapy. We have documented (with arterial Doppler studies) the circulation of the lower extremities before and after EECP in some patients with diabetes, with marked improvement in response to EECP.
No. As a matter of fact, EECP has a therapeutic role in the management of arterial hypertension and hypertensive heart disease. If you have hypertension that is properly managed, you may undergo EECP without difficulty. Oftentimes, patients with hypertension find that their blood pressure improves as they proceed with EECP.
If your hypertension is uncontrolled, you must seek medical care to get your blood pressure under control with proper medications before proceeding with EECP.
Does EECP aggravate high blood pressure (hypertension)?
No. We have successfully treated patients as young as 35 and as old as 86 without any difficulties. Many of our patients are in their 80s, and complete the entire EECP program with excellent results.
Is there an age limit for EECP?
No. Atherosclerotic plaques are calcified and hard, and they create an obstruction that detours the blood through alternate routes of least resistance. During EECP, when blood is flowing to your heart, it will naturally bypass arteries with significant plaque and enter healthy, non-diseased blood vessels to go around the blockages. In time, these new pathways are reinforced and become lasting routes for blood to reach your heart beyond the blockages. This is why EECP is often called the “natural bypass.”
Can EECP dislodge plaque and cause a stroke or heart attack?
Missing a day of EECP therapy will not have a negative effect on the overall treatment. As with any other therapy, you are encouraged to attend all prescribed appointments. The more consistent you are with the EECP schedule, the better the results will be. The missed session will be added to the end of your program until you have a total of 35 sessions.
What happens if a patient misses an EECP session?
In our experience, EECP has been useful for other non-cardiac conditions such as erectile dysfunction, renal failure with fluid retention refractory to diuretics, and obesity-associated with fluid retention as well.
EECP has also proven to have a therapeutic role in the treatment of restless leg syndrome, hepatorenal syndrome, erectile dysfunction, syndrome X, and retinal artery occlusion.
Besides angina, is EECP useful for other non-cardiac conditions?
Most practicing cardiologists today don’t have hands-on experience with this modality. Many of the university medical centers that train cardiology fellows don’t have an EECP program. There are some logistic problems involved as well. For example, if you live in Anaheim and there is an EECP program at Cedars Sinai Medical Center in Los Angeles, you will spend about 2-4 hours traveling to and from this Medical Center for one hour of therapy every day for 35 days.
Lack of exposure to EECP and interrupted follow-ups of these patients with refractory angina pectoris discount the opportunity to see how much of a difference EECP can make in reducing symptoms and improving quality of life of these patients. What is more, there exists at present a lack of genuine interest by academia and other associated industries to support new randomized clinical trials. Finally, to make things worse, there are cardiologists who would like to see “more solid clinical data” to continue practicing “evidence-based medicine.”
Why is EECP an underutilized therapy in patients with refractory AP?
EECP Frequently Asked Questions
EECP Frequently Asked Questions
WHAT IS EECP?
Enhanced External Counterpulsation is an FDA-approved, non-invasive therapy for a heart-healthy future