.Patients with wide QRS complex tachycardias are a challenge for physicians when they are presenting in the emergency department. Symptoms associated with tachycardia can vary, from mild symptoms as lightheadedness, weakness, chest discomfort, excessive sweating and palpitations, to more severe such as dizziness, angina, pulmonary edema, pre-syncope or syncope, coming from hemodynamic instability. It is important to differentiate between the aetiologies since some of the initial treatment for tachyarrhythmia with SVT as etiology can be lethal for a patient with VT. If the patient is hemodynamically unstable urgent synchronised electrical cardioversion, or defibrillation in the case of pulseless VT, is the first line initial therapy. If the patient is hemodynamically stable the physician should use clues to differentiate etiology of wide QRS complex tachycardia. This clues are present in the medical history, physical examination and echocardiography in order to verify structural heart disease if present. Of crucial importance is high quality ECG interpretation including rate, rhythm, axis and morphology of the QRS complex using provided ECG criteria that helps us to differentiate VT from SVT. Until proven otherwise, any wide QRS complex tachycardia should be managed as a VT. In the case of VT the drugs of choice are procainamide and amiodarone with some advantage of procainamide. While ICD is used regularly for secondary prevention of SCD, there is under investigation a new concept of wearable cardioverter defibrillator indicated for patients with poor left ventricular function who are at risk for SCD but are not candidates for an ICD. Catheter ablation is an effective treatment option for patients with repetitive VT and structural heart disease. It can reduce the number of ICD shocks, but there is still not clear mortality benefit. VA-ECMO is a new and interesting approach for patients with VT and electrical storm as a rescue bridge to other treatment options.