Left atrial appendage (LAA) closure (LAAC) has emerged as an alternative prevention strategy for patients with nonvalvular atrial fibrillation and contraindications to long-term anticoagulation.1 In randomized trials studying the Watchman device (Boston Scientific, St. Paul, MN), implantation was performed under transesophageal echocardiography (TEE) guidance.1 The use of TEE often mandates the presence of general anesthesia and an additional cardiologist or anesthesiologist to perform TEE. This uses greater health care resources and adds additional complexity to the procedure.