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Despite approved treatments, a number of HF patients continue experiencing disabling symptoms due to LA hypertension, causing pulmonary congestion, pulmonary hypertension, and right heart dysfunction, at rest and\/or during exercise. LA decompression therapies, i.e., left atrial shunting through a specifically designed device (either implant-based or implant-free), are being studied in various forms of HF to alleviate LA hypertension and patients\u2019 symptoms. Despite a solid background and favorable signals from initial non-randomized clinical trials, the quest for the optimal HF candidate for interatrial shunt devices is still an area of active research that at the same time is helping to better elucidate the intricate pathophysiology of HF(pEF).<\/jats:p>","DOI":"10.1007\/s10741-025-10485-3","type":"journal-article","created":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T12:27:18Z","timestamp":1737808038000},"page":"685-696","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Left atrial shunting devices: why, what, how, and\u2026 when?"],"prefix":"10.1007","volume":"30","author":[{"given":"Leila Anna","family":"De Lorenzo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Baratto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Sala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni Battista","family":"Perego","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3003-6499","authenticated-orcid":false,"given":"Sergio","family":"Caravita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,25]]},"reference":[{"issue":"1","key":"10485_CR1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1002\/ejhf.3024","volume":"26","author":"TA McDonagh","year":"2024","unstructured":"McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, B\u00f6hm M, Burri H, Butler J, \u010celutkien\u0117 J, Chioncel O, Cleland JGF, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Skibelund AK, ESC Scientific Document Group (2024) 2023 focused update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. 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