Left atrial appendage closure (LAAC) serves as a non-pharmacological stroke prevention therapy for atrial fibrillation patients, suited for people with anticoagulation contraindications or high bleeding risks. Occluders Watchman, LAmbre and Amplatzer Cardiac Plug have received generational upgrades, with notably improved safety and clinical adaptability. For intraoperative image guidance, intracardiac echocardiography (ICE) surpasses transesophageal echocardiography (TEE) in image clarity, precision, tolerance and radiation management, and can partially replace TEE. Chinese clinical data validate the safety and effectiveness of ICE-guided LAAC, especially for seniors and patients with complex cardiac anatomy. Future technical optimization, systematic training and multi-technology integration will support more precise and extensive clinical promotion of LAAC.