Same‐day discharge after left atrial appendage occlusion: Is ICE‐guided LAAO ready for prime time?

Left atrial appendage occlusion (LAAO) is an established stroke prevention strategy in carefully selected patients with nonvalvular atrial fibrillation. There are two commercially available LAAO devices in the United States—Watchman FLX (Boston Scientific) and Amulet Device (Abbott). Since its Food and Drug Administration (FDA) approval in the United States in March 2015, more than 100,000 patients have undergone LAAO with watchman device. In addition, the FDA approved the Amulet LAAO device in August 2021 and both devices have demonstrated excellent safety and efficacy outcomes in trials and registry data. Despite the differences in device design, standard practice typically involves a short percutaneous femoral venous procedure under general anesthesia using transesophageal echocardiography (TEE) guidance for device sizing, transseptal puncture, and assessment of final implant stability. In this issue of Catheterization and Cardiovascular Interventions, Waas and coworkers report data from their single‐center analysis of 225 consecutive patients undergoing LAAO with a Watchman LAAO device under intracardiac echocardiography (ICE) guidance. Their study focused on exploring the predictors