Sudden death constitutes a significant portion of fatalities among patients with heart failure. A majority of these cases are attributed to ventricular tachyarrhythmias. Ventricular tachycardia is a common occurrence in heart failure patients, and its evaluation and treatment require specialized attention. The unique pathophysiologic changes in cardiomyopathy and heart failure increase the risk for the development of ventricular arrhythmias. Thus, targeting these changes specifically can prove beneficial in devising treatment strategies for ventricular tachycardia in heart failure. This chapter will discuss the mechanisms of arrhythmogenesis in heart failure, elucidate the diverse clinical manifestations of ventricular arrhythmias in heart failure, and outline the most appropriate approaches for managing ventricular arrhythmias in heart failure patients to mitigate the risk of recurrent arrhythmias and sudden cardiac death.