ECG-triggered Skeletal Muscle Stimulation Improves Hemodynamics and Physical Performance of Heart Failure Patients

Abstract

Background Muscular counterpulsation (MCP) was developed for circulatory assistance by stimulation of peripheral skeletal muscles. We report on a clinical MCP study in patients with and without chronic heart failure (CHF). Methods and Results MCP treatment was applied (30 patients treated, 25 controls, all under optimal therapy) for 30 minutes during eight days by an ECG-triggered, battery-powered, portable pulse generator with skin electrodes inducing light contractions of calf and thigh muscles, sequentially stimulated at early diastole. Hemodynamic parameters (ECG, blood pressure and echocardiography) were measured one day before and one day after the treatment period in two groups: Group 1 (9 MCP, 11 no MCP) with ejection fraction (EF) above 40% and Group 2 (21 MCP, 14 no MCP) below 40%. In Group 2 (all patients suffering from CHF) mean EF increased by 21% (p<0.001) and stroke volume by 13% (pp<0.001), while end systolic volume decreased by 23% (pp<0.001). In Group 1, the increase in EF (6%) and stroke volume (8%) was also significant (pp<0.05) but less pronounced than in Group 2. Physical exercise duration and walking distance increased in Group 2 by 56% and 72%, respectively. Conclusions Noninvasive MCP treatment for eight days substantially improves cardiac function and physical performance in patients with CHF.

Therapeutic Value of Muscular Counterpulsation After Coronary Bypass Grafting Operation

“…External counterpulsation is a noninvasive method of assisted circulation. It is based on the ability to transform peripheral vessel resistance from being static to dynamic as well as to synchronize it with the heartbeat in a counterpulsation mode from “systole to diastole.” 8,9 …”

“…For this subgroup analysis the total number of patients was too small. Previously 9 patients with heart failure were treated by MCP and showed a good response to therapy. Postoperative hospitalization is rather long with 12 to 14 days but this is due to the fact that patients are sent home directly after operation and are not referred to any rehabilitation center for postoperative care.…”

“…For this subgroup analysis the total number of patients was too small. Previously 9 patients with heart failure were treated by MCP and showed a good response to therapy.…”

“…This enables the muscles to recover between consecutive contractions. Thus, the heart is assisted during every beat (1:1 mode) by four different groups of muscles that were stimulated once every fourth beat (1:4 mode) 6‐11 . The stimulation protocol was designed to give sufficient support of the heart without symptoms of muscle fatigue.…”

“…Based on our previous studies, 10 to 20 minutes of acute MCP is associated with a positive hemodynamic response 8,9 . Consequently, the treatment group had daily MCP treatment for 30 minutes during the initial 8 postoperative days.…”