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Outcomes of patients with successfully converted paroxysmal supraventricular tachycardia after four hours of observation in an emergency department of a district hospital in Hong Kong HY Chan and WL Yuen Objective: Paroxysmal supraventricular tachycardia (PSVT) is a common problem encountered in the accident & emergency department (AED). Most patients can be successfully converted to sinus rhythm by vagal manoeuvres or adenosine tri-phosphate (ATP) or may even convert spontaneously in the AED. The objective was to test the safety of a protocol in managing this group of patients. The outcomes and recurrence rate of PSVT patients who had been converted to sinus rhythm and discharged from the AED after a period of observation using a simple protocol were studied. Methods: This was a prospective study on PSVT patients aged between 18-70 years from June 2003 to August 2005. The outcomes and recurrence rates of the PSVT patients within two periods, namely, 24 hours and 90 days after discharge from the AED, were assessed by the computerized system in public hospitals under the Hong Kong Hospital Authority. Results: A total of 42 PSVT patients after successful conversion were discharged from the AED after four hours of observation. None had recurrence of PSVT within 24 hours. Four patients (9.5%) presented with recurrent PSVT within 90 days after discharge without negative outcomes. The timing of recurrence ranged from 2 to 22 days (mean 15 days). All the four patients had past history of PSVT and three of them had already been on long term anti-arrhythmic medication. One recurrent PSVT patient was arranged to undergo radiofrequency ablation. Conclusion: PSVT patients successfully converted by vagal manoeuvre or ATP or converted spontaneously can be safely discharged from the emergency department after four hours of observation under the study protocol. (Hong Kong j.emerg.med. 2006;13:140-147