Chronic heart failure (CHF) is the end stage for patients with all types of organic heart disease, and intractable heart failure and arrhythmias are the two leading causes of death in this group of patients. Epidemiological data show that there are about 5 million patients with heart failure in the United States, with more than 500,000 new cases each year, and nearly 23 million patients with heart failure worldwide, with about 2 million new cases each year. China’s 2003 data also shows that the incidence of heart failure among people aged 35 to 74 years old is about 0.9%, so it is estimated that there are more than 4 million heart failure patients in this age group in China. With the increasing incidence of coronary heart disease, hypertension and other CHF-causing diseases, the number of CHF is also increasing year by year. Although the rapid development of evidence-based medicine in recent years has brought epoch-making progress in the standardized treatment of CHF, the treatment mode of CHF has changed from hemodynamic interventions such as cardiotonic, diuretic and vasodilator to neuroendocrine interventions targeting the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS). The neuroendocrine intervention of the renin-angiotensin-aldosterone system (RAAS) and sympathetic system, the anti-myocardial remodeling model as the cornerstone of treatment, combined with hemodynamic interventions, has led to a significant improvement in mortality and survival in CHF, but the morbidity and mortality rate of CHF remains high. In this historical context, implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT), especially the latter, have become a reality. The advent of CRT has made it a reality. Therefore, this article will address the status of device therapy and its selection strategies in heart failure patients from various perspectives. The value of ICD in patients with heart failure and the progress of its indications Sudden death is the leading cause of death in patients with CHF, and it is significantly higher than the deterioration of heart failure in the composition of death in CHF patients, and the most important cause of sudden death is the occurrence of malignant arrhythmias such as ventricular tachycardia, ventricular flutter, or ventricular fibrillation. Electrical defibrillation is currently the most effective means of terminating malignant arrhythmic episodes and reducing arrhythmic deaths. Therefore, ICD has become the most important means of preventing sudden cardiac death outside the hospital. The first indication for ICDs in patients with heart failure was written in the 1998 AHA/ACC guidelines for the treatment of arrhythmic devices. The guideline specifies in the Class I indications that patients with nonsustained ventricular tachycardia in combination with coronary artery disease, old myocardial infarction, and inducible sustained ventricular tachycardia/fibrillation on electrophysiologic examination that is not suppressed by Class I antiarrhythmic agents or inducible ventricular tachycardia/fibrillation on electrophysiologic examination are Class I (Class B evidence) and Class IIb indications for ICD implantation, respectively. With the publication of the MADIT-II study in 2002, the AHA/ACC/NASPE guidelines for the treatment of arrhythmic devices were updated in that year, in which the above-mentioned Class I indications were retained and the Class B evidence was upgraded to Class A evidence. At the same time, for the first time, there is a Class IIa indication, which was tailored based on the results of the MADIT-II study. The text states: Patients with coronary artery disease at least 1 month after myocardial infarction and at least 3 months after coronary revascularization, if left ventricular ejection fraction (LVEF).