Comment: This 12 lead ECG shows recognizable QRS complexes with interspersed wide polymorphic, bizarre complexes.  Note, for example, in lead V6, where the rate is approximately 150 to 160 beats per minute, there is recognizable ventricular depolarization, with a markedly prolonged slurred and slowed terminal phase of each QRS complex and merging of the QRS and ST-T wave. A combination of marked abnormalities of depolarization ( QRS complexes) and repolarization (ST-T segment) during wide complex tachycardia generally means there is profound metabolic derangement of ventricular tissue with severe disturbance of ion channel function. This is most often seen with severe myocardial ischemia (often global), hyperkalemia, or antiarrhythmic drug toxicity. In this case, the patient has severe three vessel coronary disease with ongoing severe myocardial ischemia.