OBJECTIVE To evaluate the feasibility of double prospectively electrocardiogram (ECG)-triggered high-pitch spiral acquisition mode (double high-pitch mode) for coronary computed tomography angiography (CTCA). METHODS One hundred and forty-nine consecutive patients [40 women, 109 men; mean age 58.2 ± 9.2 years; sinus rhythm ≤70 beats/min (bpm) after pre-medication, body weight ≤100 kg] were enrolled for CTCA examinations using a dual-source CT system with 2 × 128 × 0.6 mm collimation, 0.28 s rotation time, and a pitch of 3.4. Double high-pitch mode was prospectively triggered first at 60% and later at 30% of the R-R interval within two cardiac cycles. Image quality was evaluated using a four-point scale (1 = excellent, 4 = non-assessable). RESULTS From 2085 coronary artery segments, 86.4% (1802/2085) were rated as having a score of 1, 12.3% (257/2085) as score of 2, 1.2% (26/2085) as score of 3, and none were rated as "non-assessable". The average image quality score was 1.15 ± 0.26 on a per-segment basis. The effective dose was calculated by multiplying the coefficient factor of 0.028 by the dose-length product (DLP); the mean effective dose was 3.5 ± 0.8 mSv (range 1.7-7.6 mSv). The total dosage of contrast medium was 78.7 ± 2.9 ml. CONCLUSIONS Double prospectively ECG-triggered high-pitch spiral acquisition mode provides good image quality with an average effective dose of less than 5 mSv in patients with a heart rate ≤70 bpm.