Ventricular tachycardia ablation is a mainstay of treatment for patients with structural heart disease and ventricular arrhythmias but is often compromised by hemodynamic collapse. The decision on when, whether, and what to use for hemodynamic support depends on the clinical situation, the patient’s comorbidities, and the availability of appropriate equipment and staffing. Depending on the clinical situation, a specific circulatory support device might be optimal, as certain ones may impact approach to the procedure. While there is a paucity of data supporting routine use of circulatory support during cardiac ablation, in specific cases there may be utility due to the patient’s baseline status. Other considerations include the use of hemodynamic support during surgical ablation and in the peri-ablation period. This chapter reviews the indications for use, a structured clinical decision-making approach, and the different types of hemodynamic support available for use during ventricular arrhythmia ablation.