I mpulse propagation in the heart depends on the excitability of individual cardiomyocytes, impulse transmission between adjacent myocytes, and the 3-dimensional (3D) arrangement of those cells. These factors operate across a wide range of spatial scales, and normal function at each level ensures that electric activation spreads across the cardiac chambers in a stable rhythm, which triggers efficient contraction. Perturbation of this function can give rise to rhythm disturbance and reentrant activation. The conditions necessary for reentrant arrhythmia have been known in a general sense Abstract: Impulse propagation in the heart depends on the excitability of individual cardiomyocytes, impulse transmission between adjacent myocytes, and the 3-dimensional arrangement of those cells. Here, we review the role of each of these factors in normal and aberrant cardiac electric activation, with particular emphasis on the effects of 3-dimensional myocyte architecture at the tissue scale. The analysis draws on findings from in vivo and in vitro experiments, as well as biophysically based computer models that have been used to integrate and interpret these experimental data. It indicates that discontinuous arrangement of myocytes and extracellular connective tissue at the tissue scale can give rise to current source-to-sink mismatch, spatiotemporal distribution of refractoriness, and rate-sensitive electric instability, which contribute to the initiation and maintenance of reentrant cardiac arrhythmia. This exacerbates the risk of rhythm disturbance associated with heart disease. We conclude that structure-based, multiscale computer models that incorporate accurate information about local cellular electric activity provide a powerful platform for investigating the basis of reentrant cardiac arrhythmia. However, it is important that these models capture key features of structure and related electric function at the tissue scale. (Circ Res. 2013;112:834-848.)Key Words: electric anisotropy ■ electrophysiology ■ fibrosis ■ infarct border zone ■ myocardial architecture ■ normal activation ■ reentrant arrhythmia