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Heart Failure pp 97–124Cite as

Inhibition of the Sympathetic Nervous System

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Abstract

Activation of the sympathetic nervous system (SNS) is a fundamental component of the pathophysiology of heart failure, especially heart failure with reduced ejection fraction (HFREF). Prolonged SNS activation contributes to several of the clinical sequelae of HFREF, such as loss of contractile reserve, ventricular remodeling, and sudden cardiac death. Over the last 30 years, extensive clinical research has shown that inhibition of the SNS in patients with heart failure improves outcomes including mortality, hospitalization for heart failure, progression of symptoms, and sudden cardiac death. The cornerstone therapy for inhibiting the SNS is administration of drugs that act as antagonists of the β-adrenergic receptor (β-blockers). A robust body of evidence shows that β-blockers reduce symptoms and improve outcomes in all patients with HFREF. Non-pharmacologic therapies that also have been found to improve outcomes in patients with heart failure, such as cardiac resynchronization therapy (CRT) and exercise training, mediate their beneficial effects via inhibition of the SNS. Here, we review the literature that supports the use of these pharmacologic and non-pharmacologic therapies and offer practical advice regarding their application in clinical care.

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Authors and Affiliations

  1. Cedars-Sinai Heart Institute, 8536 Wilshire Blvd #302, Los Angeles, CA, 90211, USA

    Evan P. Kransdorf MD, PhD

  2. Mayo Clinic Arizona, Department of Cardiovascular Diseases, 5777 East Mayo Blvd., Phoenix, AZ, 85259, USA

    D. Eric Steidley MD

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Correspondence to D. Eric Steidley MD .

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  1. Division of Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA

    Howard Eisen

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Kransdorf, E.P., Steidley, D.E. (2017). Inhibition of the Sympathetic Nervous System. In: Eisen, H. (eds) Heart Failure. Springer, London. https://doi.org/10.1007/978-1-4471-4219-5_6

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