Left atrial appendage (LAA) occlusion is an alternative therapy for stroke prevention in atrial fibrillation patients. Currently, some centers use intracardiac echocardiography (ICE) to guide LAA closure to avoid general anaesthesia. However, data are lacking regarding the amount of experience required to achieve optimal procedural results with LAA occlusion under ICE Guidance. The aim of this study was to assess how operator experience affects the procedural results of LAA occlusion under ICE guidance. In our center, all percutaneous LAA occlusion are performed by two operators using ICE guidance, placing the ICE catheter in the left atrium through a separated transseptal access. We performed a retrospective analysis of the first 65 consecutive patients who such procedure with Amplatzer Cardiac Plug (ACPTM) and second-generation AmuletTM (St.Jude Medical Inc. St.Paul’s MN) under left atrial ICE guidance in our institution from October 2012 to March 2017. Patients were divided into tertiles according to the procedure date. Baseline characteristics, procedural data and in-hospital outcomes for each tertiles were compared. The overall mean age was 74±9 years; mean CHADS2, CHA2DS-VASc and HASBLED scores were 3.36±1.4, 4.7±1.4 and 3.7±1.0, respectively with no difference between the 3 tertiles. Baseline characteristics and most of comorbidities were similar between the groups. Success rate of device implantation was similar between tertiles (95.2% vs 100% vs 95.5%; p=0.5). A significant reduction in procedural duration (109±27 vs 95±24 vs 82.4±34.6 minutes; p = 0.01), mean contrast volume (174±71 vs 126±54 vs 101±40 milliliter ; p = 0.001), and fluoroscopy times, 27±9 vs 22±10 vs 15.7±5 minutes; p < 0.0001) were seen across the 3 tertiles. In addition, a significant reduction in need for upgrading or downgrading ACP device (33.3% vs 13.6% vs 0%; p=0.01) was noted across the 3 tertiles. Rates of procedural complications was similar between tertiles. Experience accumulated over 65 LAA occlusion procedures under ICE guidance was associated with a significant decrease in procedural time, radiation dose and contrast use. In addition, the learning curve led to a better selection of occluder device size. The learning curve observed in our center could be related to the occlusion procedure, the ICE guidance, or both. Experience gathered in our center and others over the last few years could help abbreviate this learning curve for new operators.