To determine the average heart rate (HR) and heart rate variability (HRV) required for diagnostic imaging of the coronary arteries in patients undergoing high-pitch CT-angiography (CTA) with third-generation dual-source CT. Fifty consecutive patients underwent CTA of the thoracic (n = 8) and thoracoabdominal (n = 42) aorta with third-generation dual-source 192-slice CT with prospective electrocardiography (ECG)-gating at a pitch of 3.2. No beta-blockers were administered. Motion artifacts of coronary arteries were graded on a 4-point scale. Average HR and HRV were noted. The average HR was 66 +/- 11 beats per minute (bpm) (range 45-96 bpm); the HRV was 7.3 +/- 4.4 bpm (range 3-20 bpm). Interobserver agreement on grade of image quality for the 642 coronary segments evaluated by both observers was good (kappa = 0.71). Diagnostic image quality was found for 608 of the 642 segments (95%) in 43 of 50 patients (86%). In 14% of the patients, image quality was nondiagnostic for at least one segment. HR (p = 0.001) was significantly higher in patients with at least one non-diagnostic segment compared to those without. There was no significant difference (p > 0.05) in HRV between patients with nondiagnostic segments and those with diagnostic images of all segments. All patients with a HR < 70 bpm had diagnostic image quality in all coronary segments. The effective radiation dose and scan time for the heart were 0.4 +/- 0.1 mSv and 0.17 +/- 0.02 s, respectively. Third-generation dual-source 192-slice CT allows for coronary angiography in the prospectively ECG-gated high-pitch mode with diagnostic image quality at HR up to 70 bpm. HRV is not significantly related to image quality of coronary CTA.