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Ventricular arrhythmias (VAs), including electrical storm, are part of the natural history of adHF, being associated with morbidity, mortality, and missing of effective therapeutic options. Management often requires intensive care, deep sedation, autonomic modulation, multiple antiarrhythmic drugs, and mechanical circulatory support (MCS), while non\u2010responders have very limited alternatives. Heart transplantation (HTx) remains the gold standard therapy, although its availability is constrained by the lack of donors and strict allocation criteria. VAs are major drivers of urgent HTx listing across allocation systems. In recent years, catheter ablation (CA) has evolved into a disease\u2010modifying therapy for scar\u2010related VAs, with improvements in safety, mapping resolution, and procedural efficacy. Although randomized data in adHF populations remain limited, observational studies and contemporary trials demonstrate that CA can significantly reduce arrhythmic burden, implantable cardioverter\u2010defibrillator shocks, hospitalizations, and the need for urgent HTx, particularly when performed early in the disease course. Advances in substrate\u2010based strategies, functional mapping, multipolar and omnipolar technologies, and integration of cardiac imaging have enhanced procedural precision, while preprocedural risk stratification tools guide the use of MCS to improve safety in high\u2010risk patients. Emerging therapies, including pulsed\u2010field ablation, stereotactic arrhythmia radiotherapy, and autonomic modulation, alongside multimodal imaging, are expanding treatment options for refractory VAs in end\u2010stage cardiomyopathy. This review provides a comprehensive state\u2010of\u2010the\u2010art overview of VA mechanisms, patient selection, ablation strategies, and future directions in the management of severe VAs in adHF, with a focus on patients awaiting HTx.<\/jats:p>","DOI":"10.1111\/pace.70222","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T12:06:04Z","timestamp":1776254764000},"page":"717-732","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Catheter Ablation of Ventricular Tachycardia in Patients Awaiting Heart Transplantation: Practice and Perspectives"],"prefix":"10.1111","volume":"49","author":[{"given":"Alberto","family":"Preda","sequence":"first","affiliation":[{"name":"De Gasperis Cardio Center Electrophysiology Unit Niguarda Hospital  Milan 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