Overall, ventricular tachycardias (VTs) may occur at all stages of HF, whereas monomorphic VT usually is driven by a stable substrate; polymorphic, pleomorphic and rarely monomorphic VT may be induced by worsening HF. Ventricular tachycardias (VT) complicating the evolution of patients with documented heart failure (HF) are associated with a high mortality. The management of patients with HF and VT is multimodal based on pharmacological, device and respectively interventional therapy. Frequently a VT episode is the first clinical event which reveals an underlying structural heart disease (SHD). Therefore, in every patient presenting with a VT, the multimodal, comprehensive clarification of the underlying SHD is of paramount importance for planning the therapeutical strategy and prognostic evaluation. On the other hand, in patients with already known SHD and recurrent VT episodes, beyond optimal HF therapy and device therapy, the most effective long-term strategy is represented by catheter ablation (CA) or antiarrhythmic medication. As VT target areas and substrate usually are colocalized, cardiac imaging has evolved as a very helpful tool not only for planning the technical approach based on substrate distribution (endocardial, epicardial, intramural) but also for preprodurally substrate distribution and ablation targets.