An 82-year-old male patient with a history of ischemic dilated cardiomyopathy with severe LV dysfunction (LVEF of 22%), remote anterior myocardial infarction, implanted with a dual chamber ICD for the primary prevention of sudden cardiac death, severe degenerative aortic stenosis treated with surgical aortic valve replacement (bioprothesis), and ischemic stroke is admitted to the Emergency Department for palpitations and pre-syncope. A 12-lead ECG was recorded at admittance and is presented in Fig. 1. An ECG after the termination of the tachycardia is presented in Fig. 2.