Objective: The aim of this study was to evaluate the image quality of 256-MDCT in atrial fibrillation and to compare the findings with those among patients in sinus rhythm. Materials: All reconstructed images were evaluated by two independent experienced readers blinded to patient information, heart rate, and ECG results to assess the diagnostic quality of images of the coronary artery segments using axial images, multi-planar reformations, maximum intensity projections, and volume rendering technique. Results: No statistical significance was detected in terms of the overall image quality between patients in sinus rhythm and with atrial fibrillation. Pearsons correlation analysis showed no significant association between image quality and mean heart rate no matter for patients in sinus rhythm or with atrial fibrillation. Similarly, there was no correlation between image quality and heart rate variability for either patients in sinus rhythm or with atrial fibrillation. Our results showed that the optimal reconstruction window depends on patients HR, and the pattern for patients in atrial fibrillation is similar to that obtained from non-atrial fibrillation patients. Conclusion: This study shows the potential of using 256-MDCT coronary angiography in patients with atrial fibrillation. Our results suggest that when appropriate reconstruction timing window is applied, patients with atrial fibrillation do not have to be excluded from MDCT coronary angiographic examinations. © 2010 Elsevier B.V. All rights reserved.