Autonomic imbalance with increased adrenergic and reduced parasympathetic activity is involved in the development and progress of heart failure (HF). Experimental data have demonstrated that stimulation of the vagus nerve is able to reverse ventricular remodeling of the failing heart. There is also evidence that increasing parasympathetic activity may stimulate the production of nitric oxide, and reduce the devastating inflammatory process involved in HF. Vagus nerve stimulation (VNS) has been successfully applied for many years to treat drug resistant epilepsy. The first study of right vagus stimulation in patients with advance HF has proven the feasibility and safety of this new approach. Long term follow-up of increased vagal tone over 12 months with a specially designed stimulating system (CardioFit, BioControl, Yehud, Israel) has demonstrated that symptoms of HF can be significantly diminished, left ventricular ejection fraction increased, and ventricular volumes reduced. These recently published data are very promising and may offer another approach for patients with advanced HF already treated with optimal medical therapy. A prospective randomized trial with a larger patient cohort is needed to confirm these beneficial results of VNS.