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Review
. 2025 Jul 19;9(8):100704.
doi: 10.1016/j.shj.2025.100704. eCollection 2025 Aug.

Atrial Shunting for Heart Failure

Alexander M Spring  1 , Andrea Scotti  1 , Julio Echarte-Morales  1 , Matteo Sturla  1 , Manaf Assafin  1 , Guillaume Bonnet  2   3 , Lorenzo D'Angelo  1 , Juan Torrado  1 , Sandhya Murthy  1 , Juan F Granada  1 , Edwin Ho  1 , Leandro Slipczuk  1 , Ulrich P Jorde  1 , Jozef Bartunek  4 , Azeem Latib  1
Affiliations
Review

Atrial Shunting for Heart Failure

Alexander M Spring et al. Struct Heart. .

Abstract

Despite a plethora of pharmacological therapies for heart failure (HF), reducing the symptomatic burden in patients with advanced HF remains an unmet clinical need. Over the past decade, atrial shunting has emerged as a novel therapy for those with symptomatic HF despite optimal guideline-directed medical therapy. Initially thought of as a therapy reserved for those with diastolic HF, the field now spans the entire HF spectrum. In this review, we explore the physiology, devices, and trials that have shaped the field of atrial shunting. We detail how device-based interatrial shunts, no-implant interatrial shunts, and coronary sinus shunts aim to provide clinical benefit in specific patient populations and the limitations associated with their use.

Keywords: Atrial shunting; Device therapy; Heart failure with preserved ejection fraction; Heart failure with reduced ejection fraction; Interventional heart failure; Pulmonary vasculopathy.

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Conflict of interest statement

A. Latib has served on advisory boards or as a consultant for Medtronic, Boston Scientific, Philips, Edwards Lifescences, Abbott, and Ancora Heart. A. Scotti has served as a consultant for NeoChord Inc and Edwards Lifesciences. J. Echarte-Morales was supported by 10.13039/100009664Sociedad Española de Cardiología through a mobility grant (SEC/PRS-MOV-INT 22/001). G. Bonnet has received consulting fees from Medtronic, Biosensors, outside of the submitted work. U.P. Jorde has served on advisory boards for Edwards Lifesciences and Abbott; has been a consultant for Edwards Lifesciences and Abbott; and receives travel support from Ancora Heart. The other authors had no conflicts to declare.

Figures

Figure 1
Figure 1
Atrial shunt therapies for heart failure. Abbreviation: IASD, interatrial shunt device.
Figure 2
Figure 2
Physiology of atrial shunting. Abbreviations: PASP, pulmonary artery systolic pressure; PCWP, pulmonary capillary wedge pressure; RV CO, right ventricular cardiac output.
See this image and copyright information in PMC

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