Rationale: Preoperative preparation is an essential and pivotal step to reduce the patient’s surgical and anesthetic perioperative morbidity and mortality. Stress sometimes has a critical role. Paroxysmal supraventricular tachycardia is a well-known syndrome of supraventricular tachycardia, characterized by intermittent regular tachycardia rhythm, sudden onset, and abrupt termination. Cardiac atria may have a role in the induction of paroxysmal supraventricular tachycardia
Patient concerns: An elder-aged housewife widow female, Egyptian patient was documented for surgical repairing of lumber disc prolapse with happening of an accidental preoperative paroxysmal supraventricular tachycardia.
Diagnosis: Preoperative paroxysmal supraventricular tachycardia on lumbar disc prolapse in an elderly woman with a dilated left atrium.
Interventions: Electrocardiography, echocardiography, verapamil intravenous injection, and oxygenation.
Outcomes: Perioperative arrhythmias such as paroxysmal supraventricular tachycardia represent the fear for both surgeons and anesthesiologists. Perioperative electrocardiographic paroxysmal supraventricular tachycardia with evidence of p-mitral and echocardiographic evidence of left atrium dilatation in an elder-aged female patient may be reasonable for postponing the decision for the operation.

Keywords:Operative preparation; Accessory pathways; Surgery and anesthesia; Supraventricular arrhythmia; Left atrium; Disc prolapse; Surgical decision

Abbreviations:AF: Atrial Fibrillations; ECG: Electrocardiogram; ED: Emergency Department; ICU: Intensive Care Unit; IHD: Ischemic Heart Disease; O2: Oxygen; POC Physician Outpatient Clinic PSVT: Paroxysmal Supraventricular Tachycardia; VR: Ventricular rate