Abstract Arrhythmogenic right ventricular dysplasia is an autosomal dominant genetic disease characterized by the progressive replacement of the myocardium with fibrous fat tissue. It is clinically characterized by arrhythmia, heart failure, syncope and, in some cases, sudden death. We report the case of a patient with such pathology, at an advanced stage, with atrial flutter and thrombus formation in the right atrial appendage, whose therapeutic option was anticoagulation and subsequent electrical cardioversion.