JACC Case Rep. 2026 Jul 2:109130. doi: 10.1016/j.jaccas.2026.109130. Online ahead of print.
ABSTRACT
BACKGROUND: Right atrial appendage (RAA) thrombosis is exceedingly rare, is usually found incidentally on imaging, and carries a high thromboembolic risk.
CASE SUMMARY: An 83-year-old man with chronic atrial fibrillation complicated by previous bleeding episodes on anticoagulation and managed most recently with a WATCHMAN device presented after a mechanical fall. Imaging work-up revealed a new incidental finding of RAA thrombosis.
DISCUSSION: This case highlights an uncommon thrombotic finding and that atrial fibrillation is a biatrial disease. Occlusion of the left atrial appendage does not eliminate the risk of right-sided thrombosis.
TAKE-HOME MESSAGES: Thromboembolic prevention in patients with chronic atrial fibrillation is challenging. Left atrial appendage occlusion devices, although effective, do not eliminate the risk of RAA thrombosis, as atrial fibrillation is a biatrial disease.
PMID:42390408 | DOI:10.1016/j.jaccas.2026.109130