Interatrial Septal Devices for HFpEF: What We Learned from REDUCE LAP-HF

Purpose of review Elevated left atrial pressure is a common physiologic perturbation in symptomatic heart failure. A number of interatrial septal devices (IASD) are being studied with a goal of reducing left atrial pressure at rest and during exertion to improve symptoms. Our review discusses historical perspectives, physiologic rationale of IASD therapy, and summarizes recent results and ongoing studies. Recent findings Although preliminary studies showed promising hemodynamic results and improvements in function capacity, the recent sham-controlled, randomized REDUCE LAP-HF II trial failed to meet its primary endpoint. Several exploratory analyses have been performed suggesting benefits could be limited to a more selective phenotype. Summary Despite challenges, IASD as a therapeutic strategy remains promising. Several on-going studies will determine if certain patient phenotypes may benefit from this therapy.