The investigators sought to evaluate the feasibility and safety of surgical sympathetic blockade in systolic heart failure patients and secondary to assess its cardiovascular consequences.

Inclusion Criteria:

• chronic heart failure (at least 1 month of symptoms onset)
• NYHA functional class II or III
• LV ejection fraction 40% or lower
• resting heart rate higher than 65 bpm
• either maximum beta-blocker therapy according to guidelines or no beta-blocker use for intolerance.

Exclusion Criteria:

• NYHA functional class I or IV
• cardiogenic shock
• resting heart rate ≤ 65 bpm
• systolic blood pressure < 90 mmHg
• sustained ventricular tachycardia
• eligibility to other surgical procedures
• procedure-limiting comorbidity
• presence of ICD or pacemaker
• valvar, chagasic or congenital cardiomyopathy
• age > 70 years
• patient refusal
• contra-indication to videothoracoscopy
• decompensated thyroid disease
• atrial fibrillation or flutter
• active infection