The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has increased exponentially. Pulmonary congestion is a potentially life-threatening complication of peripheral VA-ECMO. Recently updated guidelines argue for a low threshold of left ventricular (LV) unloading. Although the optimal method of LV unloading is still a matter of debate, the percutaneous approaches became an increasingly used option over time. Here, we present a case of LV unloading with the Atrial Flow Regulator (Occlutech) in a patient supported with peripheral VA-ECMO.