Table 1

Contraindications to enhanced external counterpulsation (EECP)

  • Within two weeks after cardiac catheterisation or arterial puncture (risk of bleeding at femoral puncture site)

  • Arrhythmias that may interfere with triggering of EECP system (atrial fibrillation, flutter, and very frequent premature ventricular contractions)

  • Decompensated heart failure, usually class III to IV (EECP results in an increase in venous return)

  • Left ventricular ejection fraction <30% (increased preload may precipitate heart failure)

  • Moderate to severe aortic insufficiency (regurgitation would prevent diastolic augmentation)

  • Severe peripheral arterial disease (reduced vascular volume and muscle mass may prevent effective counterpulsation, increased risk of thromboembolism)

  • Severe hypertension >180/110 mm Hg (the augmented diastolic pressure may exceed safe limits)

  • Aortic aneurysm or dissection (diastolic pressure augmentation may be deleterious)

  • Pregnancy or women of childbearing age (effects of EECP on fetus have not been studied)

  • Venous disease (phlebitis, varicose veins, stasis ulcers, prior or current deep vein thrombosis or pulmonary embolism)

  • Severe chronic obstructive pulmonary disease (no safety data in pulmonary hypertension)

  • Coagulopathy with international normalised ratio of prothrombin time >2.0 (to avoid risk of haematoma with high cuff pressures)