〔Abstract〕 Objective To investigate the effect of Yangxin Yiqi Tongmai decoction combined with metoprolol on coronary heart disease (CHD) complicated with tachyarrhythmia. Methods A total of 76 patients with CHD and tachyarrhythmia diagnosed and treated in Pingdingshan Hospital of Traditional Chinese Medicine from July 2020 to December 2022 were selected and divided into a control group and an observation group according to random number table method, with 38 cases in each group. The control group was treated with metoprolol according to the conventional treatment plan, and the observation group was treated with Yangxin Yiqi Tongmai decoction combined with metoprolol. The clinical efficacy, traditional chinese medicine syndrome score, hemorheology index and occurrence of adverse reactions were compared between the two groups. Results The total effective rate of the observation group was higher than that of the control group, the difference was statistically significant (P < 0.05). After treatment, the score of symptoms in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05), After treatment, the levels of plasma viscosity and fibrinogen levels in the observation group were lower than those in the control group, with statistical significance (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion Yangxin Yiqi Tongmai decoction combined with metoprolol in the treatment of CHD patients with tachyarrhythmia can effectively improve the clinical treatment efficiency, improve clinical symptoms and hemorheology, and will not increase the occurrence of adverse reactions.