Chronic heart failure (HF) is associated with autonomic dysregulation characterized by as sustained increase in sympathetic drive and by withdrawal of parasympathetic activity. Experimental data have demonstrated that stimulation of the vague 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, reduce the devastating inflammatory process and increase the myocardial expression of gap junction proteins in HF. Several clinical trial s including CardioFit and ANTHEM-HF have proven the safety and effectivity of vague nerve stimulation (VNS) in HF patient. But recently published data from NECTAR-HF trial failed to demonstrate a significant effect on cardiac remodeling and function capacity in HF patient. A prospective randomized trial with a larger patient cohort is needed to confirm the beneficial results of VNS.