IntroductionCardiac sympathetic drive provides inotropic support to the failing heart and preserves cardiovascular homeostasis. Nonetheless, as myocardial insult evolves, this compensatory response leads to a progressive decline in contractile function, increases the vulnerability to arrhythmias and constitutes an independent mortality predictor. Despite advanced pharmacological therapies, side effects and persistent cardiac sympathetic overdrive highlights the modulation of the adrenergic system as a primary target for non‐pharmacological strategies in the heart failure (HF) treatment. In this scenario, we propose cervicothoracic transcutaneous electrical nerve stimulation (TENS) as a non‐pharmacological therapy to attenuate cardiac sympathetic overdrive in patients with heart failure.MethodsIn this prospective, randomized, sham‐controlled, double‐blind crossover trial, seven HF patients (6 men and 1 women, 54 ± 6 years of age, and body mass of 61 ± 11 kg, NYHA class II–III, ejection fraction 28.1 ± 2.5%,) were randomly assigned to either an in‐home cervicothoracic transcutaneous electrical nerve stimulation therapy (TENS: 30 min twice a day with 80 Hz frequency and pulse duration of 150 μs) or a sham control intervention (SHCI) for two weeks. Following a two‐month washout phase from TENS/SHCI, patients crossed over and started the opposite condition. Washout rate and heart‐to‐mediastinum ratio, indexes of cardiac sympathetic activity and innervation density, were obtained from planar 123l‐metaiodobenzylguanidine myocardial scintigraphy images at the beginning and end of each condition.ResultsBaseline washout rate (TENS 27.1 ± 4.4% vs. SHCI 25.2 ± 6.8%, p = 0.657), early (TENS 1.78 ± 0.1 vs. SHCI 1.78 ± 0.05, p = 0.916) and late (TENS 1.74 ± 0.19 vs. SHCI 1.68 ± 0.16, p = 0.222) heart‐to‐mediastinum ratios were similar between both conditions. While early and late heart‐to‐mediastinum ratio did not change throughout the study (p > 0.05), TENS, but not SHCI, promoted a significant reduction in the washout rate (TENS ‐ 12.8 ± 4.3 vs. STHI + 8.0 ± 8.9%, p = 0.03).ConclusionThese findings indicate that short‐term TENS therapy attenuates cardiac sympathetic overdrive in patients with heart failure with no impact on myocardial innervation density.Support or Funding InformationGrant Funding Source: CAPES, CNPq, FAPERJ, FINEP and IEN