This paper reviews current recommendations on the appropriate evaluation and management of cardiac arrhythmias in the pregnant patient. Most arrhythmias during pregnancy are benign and require no intervention. When required, the decision to treat should be based on symptom severity and the associated risk to mother and fetus posed by potentially recurring arrhythmia episodes throughout the pregnancy. Any treatment strategy in this patient population has inherent risk to both mother and unborn child. Before the initiation of any intervention, documentation of a clinical arrhythmia and correlation with clinical symptoms should be obtained. There is no role for empiric therapy.