With the introduction of spiral/helical multislice CT, medical x-ray CT began a transition into cone-beam geometry. The higher speed, thinner slice, and wider coverage with multislice/cone-beam CT indicate a great potential for dynamic volumetric imaging, with cardiac CT studies being the primary example. Existing ECG-gated cardiac CT algorithms have achieved encouraging results, but they do not utilize any time-varying anatomical information of the heart, and need major improvements to meet critical clinical needs. In this paper, we develop a knowledge-based spiral/helical multislice/cone-beam CT approach for dynamic volumetric cardiac imaging. This approach assumes the relationship between the cardiac status and the ECG signal, such as the volume of the left ventricle as a function of the cardiac phase. Our knowledge-based cardiac CT algorithm is evaluated in numerical simulation and patient studies. In the patient studies, the cardiac status is estimated initially from ECG data and subsequently refined with reconstructed images. Our results demonstrate significant image quality improvements in cardiac CT studies, giving clearly better clarity of the chamber boundaries and vascular structures. In conclusion, this approach seems promising for practical cardiac CT screening and diagnosis.