Parasympathetic control of the heart is attenuated in heart failure (HF). We investigated possible mechanisms and sites of altered vagal control in dogs with HF induced by rapid pacing. Muscarinic blockade reduced the R-R interval by 308 ms in controls but only by 32 ms in HF, indicating low levels of resting vagal tone. Vagomimetic doses of atropine sulfate prolonged the R-R interval by 109 ms in controls and increased standard deviation of the R-R interval by 66 ms but only by 46 and 16 ms, respectively, in HF. Bradycardia elicited by electrical stimulation of the vagus nerve was also attenuated in the HF group. Conversely, muscarinic receptor activation by bethanechol, and indirectly by neostigmine, elicited exaggerated R-R interval responses in HF. To investigate possible mechanisms, we measured muscarinic receptor density (B max) and acetylcholinesterase activity in different areas of the heart. In sinoatrial nodes, B max was increased (230 Ϯ 75% of control) and acetylcholinesterase decreased (80 Ϯ 6% of control) in HF. We conclude that muscarinic receptors are upregulated and acetylcholinesterase is reduced in the sinus node in HF. Therefore, reduced vagal control in HF is most likely due to changes of presynaptic function (ganglionic), because postsynaptic mechanisms augment vagal control in HF.cholinergic; parasympathetic; autonomic ABNORMAL BAROREFLEX CONTROL of heart rate in patients with cardiac dysfunction has been recognized for over 30 years (10). Abnormalities in this reflex could be located in the afferent limb, centrally, or in efferent control mechanisms. We (7), as well as other investigators (43), have found reduced sensitivity of baroreceptor afferent fibers in a dog model of heart failure (HF) induced by rapid ventricular pacing; however, less is known about efferent vagal control mechanisms in HF. Vagal control of heart rate is a complex process involving many different components. These include central impulse generation, synapses at peripheral ganglia, synthesis and release of ACh into the synaptic cleft, uptake of ACh by muscarinic receptors, postreceptor mechanisms (including interaction with membrane proteins and intracellular signaling), and hydrolysis of ACh by acetylcholinesterase (37). Parasympathetic dysfunction could therefore be due to abnormalities at any of these sites.We recently reported that synaptic transmission involving nicotinic ACh receptors across the parasympathetic ganglion contributes to parasympathetic dysfunction in the rapid pacing model of HF in dogs (1). In that report, we showed that stimulation of preganglionic fibers resulted in attenuated end-organ sinus cycle length (SCL) responses, but bypass of the ganglion through direct stimulation of postganglionic fibers resulted in augmented SCL responses. This observation suggested that sufficient ACh could be released from postganglionic nerve fibers to interact with postsynaptic mechanisms to elicit the exaggerated response in HF. This augmented postsynaptic response in HF is likely to involve upregulated sign...