The creation of an interatrial shunt in order to decompress the right or left atrium in patients with right and left ventricular failure, respectively, has been used as an alternative therapy to improve symptoms and clinical outcomes in patients with pulmonary hypertension-right heart failure and left heart failure refractory to optimal medical therapy. If ongoing randomised clinical trials further substantiate these beneficial effects in patients with chronic HF, interatrial shunting will represent an important new approach for treating this population.