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OBJECTIVES The aim of this study was to compare the safety and hospital charges between intracardiac echocardiography (ICE)- and transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO). BACKGROUND TEE has been the gold standard imaging modality to guide LAAO. Although ICE has emerged as an alternative to guide LAAO, data on the safety, and cost effectiveness of its routine remain limited. METHODS Consecutive patients who underwent LAAO with ICE or TEE guidance at the West Virginia University Clinic were comp