Patients with systolic heart failure (HF) and structural heart disease often suffer from ventricular tachycardias (VTs), which lead to increased morbidity and mortality. Despite advancements in pharmacological therapy and the use of implantable cardioverter-defibrillators, treatment options are limited due to side effects and decreased effectiveness. Catheter ablation (CA) has emerged as a promising therapy for drug-refractory VTs, especially in patients with structural heart disease. This article reviews current knowledge on the indications, efficacy, and long-term prognosis of CA in patients with HF. Additionally, it discusses the importance of preprocedural planning, risk stratification, and emerging therapeutic strategies such as mechanical circulatory support and stereotactic arrhythmia radioablation. The complex relationship between VT and HF, as well as potential risks like acute hemodynamic decompensation, are also addressed.