Non-pharmacological modulation of the autonomic tone to treat heart failure

Eur Heart J. 2014 Jan;35(2):77-85. doi: 10.1093/eurheartj/eht436. Epub 2013 Oct 29.


The autonomic nervous system has a significant role in the pathophysiology and progression of heart failure. The absence of any recent breakthrough advances in the medical therapy of heart failure has led to the evolution of innovative non-pharmacological interventions that can favourably modulate the cardiac autonomic tone. Several new therapeutic modalities that may act at different levels of the autonomic nervous system are being investigated for their role in the treatment of heart failure. The current review examines the role of renal denervation, vagal nerve stimulators, carotid baroreceptors, and spinal cord stimulators in the treatment of heart failure.

Keywords: Autonomic nervous system; Baroreflex sensitivity; Carotid baroreceptor stimulation; Heart rate variability; Parasympathetic nervous system; Renal denervation; Spinal cord stimulation; Sympathetic nervous system; Vagal nerve stimulator.

Publication types

  • Review

MeSH terms

  • Autonomic Denervation / methods
  • Autonomic Nervous System Diseases / complications
  • Autonomic Nervous System Diseases / physiopathology
  • Autonomic Nervous System Diseases / therapy*
  • Baroreflex / physiology
  • Carotid Sinus / innervation
  • Electric Stimulation Therapy / methods
  • Heart Failure / etiology
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Humans
  • Kidney / innervation
  • Pressoreceptors / physiology
  • Renin-Angiotensin System / physiology
  • Spinal Cord Stimulation / methods
  • Sympathectomy / methods
  • Vagus Nerve Stimulation / methods