A 30-year-old man presented to the emergency department with palpitations and a heart rate over 200 beats per minute. He had a history of similar symptoms previously diagnosed as supraventricular tachycardia. Initial treatments including adenosine, cardioversion, metoprolol, and diltiazem slowed the heart rate but did not terminate the arrhythmia. The patient was diagnosed with idiopathic fascicular left ventricular tachycardia based on changes in QRS morphology and axis compared to sinus rhythm as well as evidence of AV dissociation. Verapamil was recommended as the next treatment as it specifically targets the calcium channels involved in this type of arrhythmia, unlike other treatments tried.