〔Abstract〕 Objective To analyze the clinical effect of metoprolol combine amiodarone on patients with coronary heart disease and arrhythmia. Methods A total of 82 patients with coronary heart disease and arrhythmia admitted to the Fifth People's Hospital of Jiaozuo from January 2019 to January 2022 were retrospectively selected and divided into a control group and an observation group according to different drugs, with 41 cases in each group. The control group was treated with amiodarone, and the observation group was treated with metoprolol combine amiodarone. The arrhythmia attack, ECG index, cardiac function index, blood index and incidence of adverse reactions were compared between the two groups before and after treatment. Results After treatment, the arrhythmia attack frequency, duration and dispersion of ventricular rate and QT interval in the observation group were lower than those of the control group, the differences were statistically significant (P < 0.05). The left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) in the observation group were lower than those of the control group, and the left ventricular short axis shortening rate (LVFS) and left ventricular ejection fraction (LVEF) were higher than those of the control group, the differences were statistically significant (P < 0.05). The fibrinogen, whole blood viscosity, and hematocrit of the observation group patients were lower than those of the control group, the differences were statistically significant (P < 0.05). Conclusion Metoprolol combine amiodarone can further reduce the frequency and duration of arrhythmia in patients with coronary heart disease and arrhythmia, and improve cardiac function and blood indexes.