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)