Background: Left atrial appendage occlusion (LAAO) has historically been performed using intraprocedural transesophageal echocardiography (TEE) and fluoroscopy. Multiple recent reports have described the feasibility and advantages of utilizing two-dimensional intracardiac echocardiography (ICE) for LAAO. However, in inexperienced hands, safe manipulation of the ICE catheter in the left atrium (LA) can be challenging. Objective: To assess the feasibility and efficacy of three-dimensional (3D) ICE mapping in guiding LAAO device implant compared to standard TEE imaging. Methods: We retrospectively included patients who underwent LAAO in our institution from January 2017 and October 2021. We compared baseline demographics, intraprocedural data, post-procedural complications, and outcomes. P= value of <0.05 was considered significant. A linear regression model was performed using ICE and TEE as dependent variables to model contrast dose. Results: 130 patients underwent LAAO device implantation, of which 57 underwent ICE guided LAAO and 73 underwent TEE guided implantation. There was no difference in baseline demographics or post-procedural outcomes between both groups. There was no difference in the total procedure time between ICE and TEE groups, 86 (72-107) and 83 (72-111) minutes (p=0.65), respectively. Conversely, total fluoroscopic time was significantly shorter in ICE arm 7.8 (5.6-11), compared to TEE arm 12.9 (10.5-17.6) (p= <0.001). In patients undergoing LAAO device implantation using 3D ICE technique, with each additional ICE-guided procedure, the contrast dose decreased by 0.87 mL (correlation r = -0.48, p<0.001). Conclusion: 3D ICE is safe and feasible in guiding LAAO device implantation. When compared to TEE technique, total fluoroscopic time was shorter. Additionally, with more procedures utilizing 3D ICE, contrast dose decreased in a linear fashion.