Related Resources • Heart failure • EECP

By DrRich

Dateline: August 26, 2002

Enhanced External Counterpulsation (EECP) is a procedure that has proven beneficial in patients with angina. (Click here for a description of EECP, and its use in treating angina.)  Some have long speculated that the cardiovascular effects induced by EECP might also be useful for patients with heart failure. Now, a new study published in the July/August issue of Congestive Heart Failure suggests that EECP can indeed be helpful in patients with stable congestive heart failure. 

What is EECP? 

EECP is a mechanical procedure in which long inflatable cuffs (like blood pressure cuffs) are wrapped around both of the patient’s legs. While the patient lies on a bed, the leg cuffs are inflated and deflated with each heartbeat. This is accomplished by means of a computer, which triggers off the patient’s ECG so that the cuffs deflate just as each heartbeat begins, and inflate just as each heartbeat ends. When the cuffs inflate they do so in a sequential fashion, so that the blood in the legs is “milked” upwards, toward the heart.

EECP has two potentially beneficial actions on the heart. First, the milking action of the leg cuffs increases the blood flow to the coronary arteries. (The coronary arteries, unlike other arteries in the body, receive their blood flow after each heartbeat instead of during each heartbeat. EECP, effectively, “pumps” blood into the coronary arteries.) Second, by its deflating action just as the heart begins to beat, EECP creates something like a sudden vacuum in the arteries, which reduces the work of the heart muscle in pumping blood into the arteries.

EECP is administered as a series of outpatient treatments. Patients receive 5 one-hour sessions per week, for 7 weeks (for a total of 35 sessions). The 35 one-hour sessions are aimed at provoking long lasting beneficial changes in the circulatory system.

EECP in heart failure

In the new study, 26 patients with stable congestive heart failure were enrolled to receive a standard, 35 session course of EECP.  19 patients completed the EECP sessions and were followed for 6 months afterward.  These patients showed, on average, a significant improvement in their functional capacity and quality of life.  The authors point out, as well, that the EECP was well-tolerated in these patients. 

Since there were no control subjects in this small study, no firm conclusions can be drawn about how useful EECP might be in treating heart failure.  But the study was impressive enough to launch a larger, randomized clinical trial (the Prospective Evaluation of EECP in Congestive Heart Failure - PEECH - trial,) that should provide more definitive data on how well EECP might benefit patients with heart failure.  The PEECH trial has already begun.

Despite the fact that the potential benefits of EECP in heart failure are still being evaluated, the FDA was sufficiently convinced of these benefits that it cleared the makers of the EECP system (Vasomedical) to begin promoting EECP for heart failure.

Most cardiologists have not embraced the use of EECP for heart failure, quite justifiably citing the need for larger clinical trials.  However, since (as we have previously pointed out) cardiologists don't like EECP even when it is of proven benefit, patients with heart failure who are interested in this treatment option should watch for results of the PEECH trial, and if they prove positive, should take the initiative in bringing up the option of EECP to their doctors.


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