Another early variation of aortic counterpulsation used cuffs that were wrapped around the lower legs and timed to alternately empty and fill with water in the same rhythm as the patient’s heartbeat. Today, the technique of enhanced external counterpulsation (EECP) uses cuffs filled with air instead of water. This is more comfortable for the patient and easier for the physician. The cuffs fill sequentially, filling with air all around the lower leg, rather than suddenly filling all at once.

In 1989, researchers determined that enhanced external counterpulsation continued to show helpful effects on patients even three years after treatment. Patients with angina report a decrease in episodes of chest pain, decrease in angina medication, and increase in stamina during exercise.

There are no reported risks of complication. However, EECP is not recommended in patients with certain factors, including:

Moreover, EECP is a scheduled, non-emergency procedure rather than an emergency procedure, for which an intraaortic balloon pump (IABP) may still prove to be more effective.