Surgical Sympathetic Blockade in Heart Failure

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