Wide QRS complex tachycardia (WCT) is a common clinical challenge, and can present in a variety of settings, including the emergency department, in the in-hospital setting, during operations, and even in the outpatient arena. The proper, and timely, acute management of WCT is contingent on the proper evaluation and diagnosis of the tachycardia. WCT, an arrhythmia with a QRS duration of over 120 ms, at a rate of over 100 beats per minute, can be due to either supraventricular tachycardia with aberrant conduction or due to ventricular tachycardia. The management of these two entities can vary considerably, especially if the patient presents without significant haemodynamic stability.