Cardiac arrhythmia is increasingly encountered in patients with cancer, not only as a result of shared risk factors but also as a direct consequence of malignancy and its therapies. This evolving overlap has positioned arrhythmia management as a key component of cardio-oncology practice. This review outlines current strategies for managing atrial and ventricular arrhythmias, conduction disorders, and device-related considerations in oncology patients. It emphasizes the importance of evaluating drug-drug interactions between antiarrhythmics, anticoagulants, and cancer therapies, particularly in the context of QT interval prolongation, bradycardia, or thrombocytopenia. Therapeutic decisions, such as initiating antiarrhythmics, pursuing ablation, or implanting cardiac devices, must weigh life expectancy, procedural risk, cancer stage, and overall treatment goals. Special attention is given to the timing and safety of electrophysiologic interventions in patients receiving chemotherapy, radiation, or hematopoietic stem cell transplantation. The review also explores emerging tools like remote monitoring and artificial intelligence to detect early arrhythmia, personalize therapy, and reduce complications. As cardiovascular and oncologic care become increasingly intertwined, multidisciplinary collaboration is essential to balance rhythm control with cancer treatment goals. The integration of cardiology, oncology, and electrophysiology expertise will be vital in optimizing outcomes for this high-risk population.