The recommendations of the European Society of Cardiology for the treatment of ventricular arrhythmias and the prevention of sudden cardiac death (2015) identified more than 20 risk factors for sudden death, 3 of them due to sympathetic overdrive (sympathetic hyperactivation): increased heart rate at rest, decreased heart rate variability (standard the deviation of the RR intervals is less than 40–50 ms per day), the elongation and increase in the variance of the QT interval is more than 85–100 ms.Beta-blockers are the only drugs that affect all parts of the pathogenesis of sudden cardiac death. Therefore, they act as first-line drugs (IA) both in the aforementioned Recommendations and in the Recommendations of the European Society of Cardiology for the Diagnosis and Treatment of Acute and Chronic Heart Failure (2016) as a primary component of the combination therapy of symptomatic chronic heart failure with a reduced ejection fraction of the left ventricle.According to the results of clinical trials of chronic heart failure, beta-blockers effectively reduce the risk of sudden cardiac death. Bisoprolol is the leader among them: in the CIBIS II study, it reduced the risk of sudden death by 44 %, and in the CIBIS-III study, by 46 %.