For patients with cardiac devices, cardiac computed tomography (CT) remains the mainstay for imaging due to its superior resolution as compared with echocardiography and nuclear studies and no contraindication to metal as with cardiac magnetic resonance imaging. This review focuses on the evaluation and pitfalls of coronary arterial imaging in patients with devices, such as pacemakers, implantable defibrillators, cardiac resynchronization therapy (CRT), as well as complications such as lead perforation and safety concerns of CT interference. We discuss both pre- and post-procedural CRT assessment for coronary venous imaging and pre-procedural myocardial scar assessment to localize regions of scar and peri-infarct zone to facilitate ventricular tachycardia ablation in patients with devices. We describe potential new research on dyssynchrony and integration with myocardial scar and site of latest activation for patients with or being considered for CRT. We detail the utility of CT for the assessment of proper function and complications in patients with left ventricular assist device implantation.