Vagal nerve stimulation (VNS) has a strong pathophysiological rationale as a potentially beneficial treatment for heart failure with reduced ejection fraction. Despite several promising preclinical studies and pilot clinical studies, the two large, controlled trials—NECTAR-HF and INOVATE-HF—failed to demonstrate the expected benefit. It is likely that clinical application of VNS in phase III studies was performed before a sufficient degree of understanding of the complex pathophysiology of autonomic electrical modulation had been achieved, therefore leading to an underestimation of its potential benefit. More knowledge on the complex dose–response issue of VNS (i.e., pulse amplitude, frequency, duration and duty cycle) has been gathered since these trials and a new randomized study is currently underway with an adaptive design and a refined approach in an attempt to deliver the proper dose to a more selected group of patients.

迷走神经刺激 (VNS) 具有很强的病理生理学原理，可作为治疗射血分数降低的心力衰竭的潜在有益治疗。尽管有几项有希望的临床前研究和临床试验研究，但两项大型对照试验——NECTAR-HF 和 INOVATE-HF——未能证明预期的益处。VNS 在 III 期研究中的临床应用可能是在对自主电调节的复杂病理生理学有足够程度的了解之前进行的，因此导致对其潜在益处的低估。更多关于 VNS 的复杂剂量反应问题的知识（即脉冲幅度、频率、