The incidence of iASD shortly after LAAC has been reported in several studies. For instance, Korsholm et al. compared the efficacy and safety of ICE-guided LAAC and the traditional TEE-guided LAAC of the left upper chamber, with the iASD being one of the secondary efficacy parameters. The incidence and size of the residual iASD in the ICE group at day 55 of FU were 35% and 3.5 (IQR: 1–8) mm, respectively. For the TEE group, the incidence and size of the residual iASD were 26% and 3.5 (2–6) mm, respectively, which were not significantly different between the groups (p = 0.21 for the incidence of iASD and p = 0.58 for the iASD size) [8]. Puga et al. conducted single-center research on the risk of developing iASD. Thirty patients underwent ICE-guided LAAC on the left atrium, and 36 underwent TEE-guided LAAC. The results showed that the iASD incidence was higher in the ICE group (65.4% in the ICE group vs. 40.9% in the TEE group, p = 0.048), but there was no significant difference in the size of the iASD between the two groups (5 mm (IQR 4–5.5 mm) vs. 5 mm (2–5 mm), p = 0.712) at the first FU. Multivariable analysis showed that ICE alone was associated with a higher iASD (OR = 3.745, 95%CI: 1.197–11.715) incidence [9]. In the present study, we determined the incidence of iASD at month 2 of FU after LAAC. The results showed that the ICE-guided LAAC did not increase the risk of iASD. However, the size of the iASD was numerically larger in the ICE-guided LAAC group. Compared to the above reports, the incidence of iASD in our study was relatively low, and the size of the iASD was small. The mean iASD in the ICE group in this study was only 2.8 mm. For the long-term occlusion rate, Chen et al. reported that the incidence of iASD after the ICE-guided LAAC procedure dropped from 57.9% at month 2 of FU to 4.2% at month 12 of FU [12]. In our study, the incidence of iASD in the ICE-guided LAAC group was 21.4% at month 2 of FU, and the occlusion rate of iASD at month 12 of FU was 70.6%. Nelles et al. reported that the incidence of iASD under TEE-guided LAAC dropped from 34.7% at month 3 of FU to 18.1% at month 12 [13]. Singh et al. reported that the incidence of iASD in 253 patients in a “PROTECT AF” cohort at month 12 of FU was 6.8% [14]. The occlusion of iASD over time is a common phenomenon. To sum up, the short-term and long-term incidence and size of iASD following ICE-guided LAAC in our study are within the acceptable range.