Clinical studies have shown that EECP treatment can help decrease symptoms of angina in people with coronary artery disease (CAD) who, due to underlying health issues, are not good candidates for surgery. Major medical organizations suggest considering EECP treatment for those with angina who are not helped by other options.

This article explains how EECP therapy works, its effectiveness, and its risks. It also covers when healthcare providers recommend it.

What Is EECP?

With EECP, long, inflatable cuffs are wrapped around both legs and inflated/deflated in tandem with each heartbeat to encourage better blood flow.

This mechanical procedure is done sequentially, from the lower part of the legs to the upper, so that the blood in the legs is “milked” upward toward the heart.

The inflation and deflation are controlled by a computer that receives data from an electrocardiogram (ECG)—a machine that records the electrical activity of your heart. Inflation of the cuffs is triggered early in diastole (when the heart relaxes and is filled with blood). Deflation occurs just as systole (heart contraction) begins.

EECP Therapy Benefits

EECP therapy has at least two potentially beneficial actions on the heart:

First, the milking action of the leg cuffs increases the blood flow to the coronary arteries during diastole. (Unlike other arteries, coronary arteries receive their blood flow in between heartbeats, not during them. ) Second, by deflating just as the heart begins to beat, EECP creates something like a sudden vacuum in the arteries. This reduces resistance in the blood vessels of the legs so that blood can be pumped more easily from your heart, and may also help reduce endothelial dysfunction.

In addition, there is some evidence that EECP may:

Help induce the formation of collateral (small) blood vessels in the coronary artery systemStimulate the release of key chemicals within endothelium tissue, which lines the coronary arteriesAct as a form of “passive” exercise, leading to the same sorts of lasting beneficial health changes that are seen with real exerciseImprove peripheral arterial function, which serves to reduce the oxygen demand on heart muscle

EECP is safe and well tolerated. It is supported by available evidence (albeit imperfect) that strongly suggests the treatment is quite effective in many cases.

In addition, those being treated can tell pretty definitively whether it substantially reduces angina symptoms.

How Effective Is EECP Therapy?

Several studies suggest that EECP therapy can be quite effective in treating chronic stable angina. Some have shown that improvement in symptoms seems to persist for up to five years, though some patients may require another course of EECP to maintain this.

The effects of EECP also are being studied for treating other conditions, such as diabetes and heart failure.

One review of 823 cases included in eight different studies found that EECP can improve physical exercise tolerance and certain heart functions in people living with heart failure, but more study is recommended.

EECP therapy may be considered for anyone who still has angina despite maximal medical therapy, and in whom stents or bypass surgery are deemed unsuitable options.

In 2014, several professional organizations finally agreed in a focused update that EECP treatment ought to be considered for patients with angina that’s not helped by other treatments. These organizations are:

The American College of CardiologyAmerican Heart AssociationAmerican Association for Thoracic SurgeryPreventive Cardiovascular Nurses AssociationSociety for Cardiovascular Angiography and InterventionsThe Society of Thoracic Surgeons

EECP isn’t for everyone, but you may want to consider it if you are diagnosed with angina and your cardiologist’s assessment for treatment does not include surgery.

You also may want to ask a healthcare provider about its emerging uses for other conditions, such as long COVID care.

EECP Therapy Contraindications

EECP can be somewhat uncomfortable but is generally not painful. In studies, the large majority of patients have tolerated the procedure quite well.

However, not everyone can have EECP therapy. You probably should not have EECP if you have:

Heart rate over 120 beats per minute Aortic insufficiency Recent cardiac catheterization Irregular heart rhythm such as atrial fibrillation Severe hypertension (high blood pressure) Peripheral artery disease involving the legs A congenital heart defect Hypertrophic cardiomyopathy Valvular disease Enlarged heart A pacemaker Pulmonary hypertension History of deep venous thrombosis

Why Isn’t EECP Used More Often?

Your cardiologist may not have offered EECP treatment to you for several reasons, including your underlying health history and specific treatment plan. It’s not considered a first-line treatment for angina, even though it can decrease the need for common medications like nitroglycerin.

Treatment availability also may be a factor, because not all communities have accessible EECP equipment. Patient travel time can be a barrier to keeping appointments and completing the necessary full course of EECP treatment.

EECP has become more common in the United States, though, and about 1,200 machines are now in operation across the country.

Summary

Enhanced external counterpulsation (EECP) therapy is a safe and effective alternative to surgery when treating angina (chest pain) in people with coronary artery disease. It may have uses for other conditions that remain under study, including heart failure, diabetes, and long COVID.

Medicare has approved coverage for EECP for patients with angina who have exhausted all other treatment options.

EECP works by using inflatable cuffs to apply pressure to your lower legs. The pressure is synchronized to your heartbeat to improve blood flow and heart function.

While EECP is not an option for everyone, such as those with a pacemaker, it is increasingly available in the United States. It’s also a comparatively affordable treatment. Talk to your healthcare provider to learn more about whether EECP treatment is an option for you.