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Although the pathophysiology is complex, the primary aetiology of exercise intolerance is due to an elevated left atrial pressure, particularly with exercise. In this context, device-based therapy has become a focus. Several companies have developed techniques to percutaneously create an iatrogenic left to right shunt at the atrial level, thereby reducing left atrial pressure and reducing transmitted pressures to the pulmonary circulation and reducing pulmonary congestion. In this review, we explore the pathophysiology, evidence base, benefits, and considerations of these devices and their place in the therapeutic landscape of heart failure with preserved ejection fraction.<\/jats:p>","DOI":"10.1007\/s10741-022-10236-8","type":"journal-article","created":{"date-parts":[[2022,4,19]],"date-time":"2022-04-19T09:02:53Z","timestamp":1650358973000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Device therapy with interatrial shunt devices for heart failure with preserved ejection fraction"],"prefix":"10.1007","author":[{"given":"Shane","family":"Nanayakkara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4058-0372","authenticated-orcid":false,"given":"David M.","family":"Kaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,19]]},"reference":[{"key":"10236_CR1","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1007\/s11897-013-0155-7","volume":"10","author":"AA Oktay","year":"2013","unstructured":"Oktay AA, Rich JD, Shah SJ (2013) The emerging epidemic of heart failure with preserved ejection fraction. 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SN has no conflicts of interest or financial ties to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}