Optimizing Left Atrial Appendage Occlusion: Limitations of TEE and the Emerging Role of Multimodality Imaging

This letter critically appraises the recent study by Long et al. investigating the role of transesophageal echocardiography (TEE) in guiding and evaluating left atrial appendage occlusion (LAAO) among patients with non-organic heart disease. While the authors demonstrate the procedural utility of TEE, its limitations, including invasiveness, patient tolerance, and lack of long-term data, remain notable. Current literature highlights the growing role of intracardiac echocardiography (ICE) and computed tomography (CT) as alternative or complementary modalities. Larger multicenter studies integrating these approaches are warranted to optimize procedural outcomes and patient safety in atrial fibrillation-related stroke prevention.