RATIONALE: Primary cardiac angiosarcoma is very rare with a poor prognosis, and there is no recognized guideline for its diagnosis and treatment. Currently, there is no standardized adjuvant chemotherapy regimen following radical surgery for cardiac angiosarcoma. To date, the literature lacks reports on the use of albumin-bound paclitaxel as an adjuvant chemotherapy agent in this context. This case report aims to document and evaluate the imaging characteristics of the disease and the efficacy of albumin-bound paclitaxel as adjuvant chemotherapy, thereby providing valuable insights for clinical diagnosis and treatment. PATIENT CONCERNS: We report a 70-year-old patient with right atrial angiosarcoma, who presented with atrial fibrillation as the initial symptom. DIAGNOSES: Transesophageal echocardiography, chest computed tomography, and cardiac magnetic resonance imaging showed a right atrial mass. INTERVENTIONS: After radical resection, the patient was given 4 cycles of albumin-bound paclitaxel adjuvant chemotherapy. OUTCOMES: Multiple metastases occurred in a short period of time, and the patient died 13 months after surgery. Surgical resection is the most important treatment for cardiac angiosarcoma, and the optimal adjuvant therapy needs to be further studied. LESSONS: The limitation of this case report is its reliance on a single case, resulting in a limited sample size. To comprehensively characterize cardiac angiosarcoma and evaluate the efficacy of albumin-bound paclitaxel chemotherapy, future studies should collect additional cases and conduct long-term follow-up.