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Abnormalities of autonomic tone — both sympathetic activation and parasympathetic deactivation — are common in heart failure (HF). Beta blockers, which blunt sympathetic activation, substantially improve outcomes in HF patients with reduced systolic function. Whether enhancing parasympathetic tone might also have benefits is unknown, although two recent small studies of vagal nerve stimulation (VNS) had negative results (NECTAR-HF, N=96, and ANTHEM-HF, N=60). Now, in a manufacturer-sponsored, open-label study, researchers randomized 707 patients with HF (mean age, 61; 79% men) in a 3:2 ratio to VNS with an implantable device plus medical therapy or medical therapy alone. Patients had New York Heart Association class III symptoms and left ve…