Introduction: An imbalance in the Autonomic Nervous System (ANS) is a central pathophysiologic
mechanism in Heart Failure (HF) and has been a principal target of treatment in these patients.
Traditional pharmacologic agents do not provide specific modulation of discrete arms of the ANS, while
side effects may lead to poor tolerance. Technological advances have provided a series of invasive
methods that may provide a focused effect on the ANS in selected patient groups. Renal denervation,
initially targeted for patients with resistant hypertension, has given positive preliminary results in terms
of heart structure and function. Baroreceptor stimulation also has ongoing research with respect to its
efficacy and longer term effects in HF patients. Vagal nerve stimulation and spinal cord stimulation
have limited data but represent novel treatments that target the hard to reach parasympathetic system.
Conclusion: The present review overviews the pathophysiologic basis, current preclinical and clinical
data and future expectations of these promising treatments.