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This study assessed the relationship between cardiac electrophysiological indicators and blood lipid parameters in patients with coronary artery disease complicated by arrhythmia and evaluated their combined influence on the development of heart failure. A cohort of 240 patients admitted to the Cardiac Center of The First Affiliated Hospital of Xiamen University between April 2023 and April 2025 was screened; 80 met the inclusion criteria and were included in the analysis. Participants were categorized according to the occurrence of heart failure. Clinical characteristics, including lipid profiles (triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and total cholesterol), were analyzed alongside echocardiographic parameters, including left ventricular ejection fraction (LVEF) and carotid intima-media thickness (CIMT). Statistical analyses included correlation testing, multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis. Impaired cardiac function, increased CIMT, and abnormal lipid concentrations were significantly associated with heart failure risk. QTc interval showed positive correlations with LDL-C (r = 0.342, P < 0.01) and triglycerides (r = 0.366, P < 0.01), whereas HDL-C showed inverse correlations with electrocardiographic parameters. In multivariable logistic regression analysis, prolonged QTc interval (OR = 1.08, 95% CI: 1.02-1.15), widened QRS duration (OR = 1.05, 95% CI: 1.01-1.11), elevated LDL-C (OR = 1.74, 95% CI: 1.12-2.63), increased triglycerides (OR = 1.62, 95% CI: 1.05-2.48), reduced HDL-C (OR = 0.68, 95% CI: 0.50-0.91), and decreased LVEF (OR = 0.89, 95% CI: 0.83-0.94) were independent predictors of heart failure. ROC analysis confirmed the predictive value of multiple risk factors, with AUCs ranging from 0.68 to 0.75. HDL-C had the highest predictive accuracy individually (AUC = 0.75), while QTc interval and LVEF also demonstrated strong discrimination (AUC = 0.73).