Patients with structural heart disease and ventricular tachycardia (VT) can be difficult to manage clinically. Many treatment options are available, but no single approach can be applied to every patient. This review aims to discuss the current options available for the management of this population. VT can be associated with cardiomyopathy of any etiology, both ischemic and nonischemic. Antiarrhythmic drugs have not been shown to decrease mortality in this patient population, but they can help reduce episodes. While the advent of the implantable cardioverter-defibrillator has revolutionized the treatment of VT, patients with recurrent shocks for VT have high morbidity and mortality. The development of catheter ablation over the past few decades has greatly aided the ability to control VT in these patients. The approach to patients with VT and structural heart disease is multifaceted. Often, a combination of therapeutic techniques is required to obtain the best result.