EECP – Enhanced External Counterpulsation
EECP is an enhanced external counterpulsation. It is cost effective, non invasive, non surgical, non pharmaceutical, out patient therapy for Angina, Heart attack and heart failure patients. It is FDA (USA) and NHS (UK) approved.
How is EECP Performed?
During EECP Patient lies on bed of machine. Three or five electrodes are applied to the chest to record a constant ECG.
A Plethysmograph is applied to index finger to record a tracing that represents blood pressure and oxygen saturation.
Set of 3-4 cuffs is wrapped around the calves, thighs and buttocks. EECP system uses an ECG signal to electronically synchronize inflation and deflation of the cuffs.
What is duration of treatment?
Duration for chronic angina and heart failure patients is 35 hours usually one hour per day, five days a week. Some patients choose a 2-hour per day regimen, which reduces the time of completion of treatment. The duration of treatment and interval of rest will depend on the patient’s condition, how much diastolic augmentation is obtained, tolerance of patient and the indications for application of EECP.
What is Mechanism of EECP?
Clinical studies indicate that EECP treatment may create a ‘natural’ bypass of blocked arteries. There are basically two mechanisms involved in this therapy. When we produce diastolic augmentation, this results in opening of lot of inactive blood vessels in heart which helps in bypass the blocked channels. Moreover, this treatment encourages blood vessels to form new small vessels i.e colletrals. These channels or collaterals may eventually become permanent pathways to the heart muscle that was previously deprived of blood flow and adequate oxygen.
What are indications of EECP?
Angina patients who are not relieved by medicine, patients who dont want to have bypass surgery, patients who are contraindicated for bypass or angioplasty like kidney failure, liver failure, severe COPD cases, Diffuse diabetes disease, very old age, patients of Syndrome X, i.e microvessel disease, ischaemic and dilated cardiomyopathy patients all can go for EECP.
What are contraindications of EECP?
Severe aortic regurgitation and aortic stenosis, deep vein thrombosis, pregnancy, very high blood pressure and severe peripheral vascular disease are contraindications for EECP
Side Effects of EECP
EECP has no side effects except little skin bruises specially when patient is not wearing proper skin pants during treatment. In contrast to angioplasty or bypass, it is completely safe procedure with no major risk to patient.
Benefits to the patient
After EECP, patient can walk longer distance without feeling chest pain or breathlessness. Patient’s quality of life improves remarkably. He can take part in daily activities. Above all, patients medicine also decreases, there is less need to take sub lingual nitrates. After treatment heart failure patients don’t have to take high quantity of diuretics.
EECP results verification.
Before and after treatment we perform ECG, Echocardiography, TMT test and Stress thallium scan. All these tests verify the results of EECP. In ECG there is mark decrease in ST segment depression or other ischaemic changes, there is increase in Ejection fraction in Echo, TMT test shows that patient can walk longer distance without chest pain, and stress thallium test also shows that there is less or no more ischaemia in heart.
What is Cost of EECP?
The charge for EECP is approximately one third that of angioplasty and one sixth the cost of coronary artery bypass surgery. In Pakistan EECP charges are US $ 2400 at Dr. Armughan EECP heart Clinic Sialkot.
Insurance & Medicare Coverage
In USA, over 120 insurers are covering EECP. EECP has been covered locally by Paramount, John Hancock, Senior Sense, Paramount Elite, Workman’s Comp, HMO Health Ohio, Messa, Acordia, Access, Envirosource, EV Benefits, First Health, Harrington Benefits, Fortis, Gallagher Benefits, NGS American, United Health Care, Health Alliance Plan, Medical Mutual, Anthem, most Blue Cross/Blue Shield plans, Aetna, Family Health Plan,and Fountainhead. Pre-authorization is required for FHP, Paramount, Senior Sense, Paramount Elite, and HMO Health Ohio patients. Medicare and Medicaid cover EECP in patients with class 3 or class 4 angina (chest Pain) who are not good candidates for bypass surgery (CABG)