Effects of Cardiac Sympathetic Blockade in Patients With Chronic Heart Failure, a 2-year, Prospective, Randomized Cohort Study

Although current pharmaceutical therapies have improved the survival rate in heart failure it remains a fatal disease and is associated with a poor 3-year survival. Increased sympathetic activity found in patients with heart failure plays an important role in the pathogenesis and development of the disease[Provide reference]. Excessive activation of sympathetic tone contributes to arrhythmogenesis, increased cardiac wall tension, and platelet aggregation, promoting a "vicious cycle[What cycle? Elaborate. ]" in these patients.

High thoracic epidural anesthesia (HTEA) can reversibly and regionally block the cardiac sympathetic nervous system. The method was pioneered by Prof. Liu Fengqi in 1995, and he has accumulated clinical experiences from thousands of cases. His anecdotal experience indicates that the method can favorably improve intractable angina, dilated cardiomyopathy, and advanced heart failure. Though the method has been used to treat patients at our center for many years, there has been no prospective trial of its effects on cardiovascular function, or its efficacy to improve clinical outcomes.

The investigators propose to investigate the immediate physiologic effect and clinical effectiveness of HTEA in treating heart failure.

Methods and design The investigators propose a double-blind placebo-controlled clinical trial. 230 chronic heart failure patients with the course of more than three months will be randomly allocated two groups, 90 in HTEA group, 90 in sham-HTEA (SHAM) group. The investigators will compare their outcomes to 50 historical controls (CON). Ethical approval from our institutional review board will be obtained. Patients will be consented appropriately, and be free to withdraw from the study at any time.

According to the guidelines for chronic heart failure treatment, diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, aldosterone receptor antagonists, digitalis, and vasodilating agents should be used as standard treatments for heart failure in the three groups.