In the presence of arrhythmias in refractory heart failure, attention should be paid to finding and correcting reversible factors, and treatment should focus on managing arrhythmias with hemodynamic disturbances, because it is a direct threat to the patient’s life and the main reason why refractory heart failure is not easily controlled. The main manifestations of severe arrhythmias are ventricular tachycardia and ventricular fibrillation, frequent multi-source premature ventricular contractions, supraventricular tachycardia and rapid atrial fibrillation. 1. Treatment of supraventricular tachycardia and rapid atrial fibrillation with hemodynamic disorders Rapid atrial fibrillation and supraventricular tachycardia with hemodynamic disorders such as hypotension and impaired consciousness should be given immediately with synchronized direct current cardioversion. The patient should be placed in a flat position with the pillow removed, the denture removed, and the patient put to sleep by intravenous imipramine 3-5 mg or valium 20-30 mg, depending on the patient’s sanity. The dose is based on the patient’s mental condition. The patient is painless and can wake up as soon as possible after the electric shock; do not overdose for the elderly to avoid respiratory depression; do not ask too many questions to the patient during the injection to avoid prolonging the sleeping time. Imipramine works fast, short duration, superior to Valium, in addition Valium sometimes causes patient agitation. The first shock energy is generally 100-200J, if the resuscitation is not successful, each time to increase the electrical energy 50-100J, again shock 1 to 2 times, if 300J is still unsuccessful to give up the electric resuscitation. 2, ventricular tachycardia, ventricular fibrillation with hemodynamic disorders treatment must be immediately suspended by electric shock, ventricular tachycardia using synchronous electric resuscitation, electric defibrillation method and energy with supraventricular tachycardia patients electric resuscitation. Ventricular fibrillation is treated with asynchronous electrical defibrillation. In case of shock resistance, it is now advocated to push 150-300 mg of amiodarone followed by 360 J of shock, and for hemodynamically stable ventricular tachycardia, pharmacological discontinuation is also available. Amiodarone is preferred for pharmacological treatment. Amiodarone is the only known antiarrhythmic drug therapy in heart failure that does not increase mortality. Once ventricular tachycardia has been aborted, measures should be taken to prevent recurrence. Its long-term treatment includes pharmacological prophylaxis, ablation and buried automated cardioverter-defibrillators (ICDs). Amiodarone is generally chosen for pharmacological prophylaxis: (1) ventricular tachycardia is easily induced by programmed or prodromal stimuli; (2) ventricular tachycardia exhibits monomorphism; (3) hemodynamic stability; and (4) the etiology is consistent with idiopathic ventricular tachycardia. ICD is an effective measure for long-term prevention of life-threatening ventricular tachycardia or ventricular fibrillation in patients with coronary artery disease MI, dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), Brugada syndrome, long QT syndrome (LQTS), and idiopathic ventricular tachycardia, who have had ventricular tachycardia or ventricular fibrillation The ICD is effective in aborting ventricular tachycardia or ventricular fibrillation (98% of cases), and it is more effective than long-term drug therapy. The lethal arrhythmia of RHF complicated by acute myocardial infarction or RHF with symptomatic frequent premature ventricular contractions requires pharmacological intervention by amiodarone. The main side effects are hypotension (often related to rapid injection) and bradycardia, especially for those with obvious cardiac dysfunction or heart enlargement, and it is necessary to pay more attention to the injection speed and monitor blood pressure. Oral amiodarone loading dose 0.2g, 3 times/d for 5-7d or 0.2g, 2 times/d for 5-7d, then 0.1-0.3g, 1 time/d for maintenance, but pay attention to individualized treatment according to the condition. This drug contains high iodine content, and the main side effect of long-term use is change in thyroid function, which should be checked regularly. Pulmonary fibrosis rarely occurs at the usual maintenance dose, but care should be taken to detect this complication early by taking a medical history and physical examination and by regular chest radiographs. The QT interval is prolonged to varying degrees during the course of the drug, which is not usually an indication for discontinuation of the drug. In elderly people or those with low sinus node function, amiodarone further suppresses the sinus node and it is advisable to reduce or suspend the drug if the sinus heart rate is <50 beats/min. Side effects include sunlight-sensitive dermatitis and corneal hyperpigmentation, but do not affect vision. Treatment of persistent atrial fibrillation The incidence of atrial fibrillation in patients with refractory chronic heart failure increases significantly with age. Prevention of thromboembolism is the main focus. The first choice of drug therapy for ventricular rate control is digoxin, which is still the first-line drug at an average dose of 0.125-0.25 mg. For thromboembolism prevention, large-scale clinical trials have demonstrated that warfarin and aspirin are both effective in preventing thromboembolism in patients with non-valvular atrial fibrillation. In comparison, warfarin was more effective, but the incidence of bleeding was higher. Compared with aspirin, warfarin is better in patients at high risk of atrial fibrillation (annual incidence of stroke >6%) than in those at low risk.