Non-technical summary Oxidative stress is a hallmark of various cardiovascular disorders that results in cellular dysfunction and death. Reactive oxygen species (ROS)-induced ROS release (RIRR) is a fundamental mechanism which amplifies ROS levels within the cardiomyocyte resulting in cellular oxidative stress. Despite elegant studies describing the phenomenon of RIRR in isolated myocytes, its biophysical properties and functional consequences in intact myocardium remain unclear. Here, we use ROS imaging to extend the concept of RIRR to the level of the intact heart. We establish regenerative superoxide production as the mediator of RIRR-related arrhythmias and reveal their strong dependence on a key mitochondrial channel, known as the inner membrane anion channel (IMAC). We demonstrate the efficacy of suppressing RIRR and related arrhythmias either by pharmacologically blocking IMAC or scavenging ROS using a synthetic superoxide dismutase/catalase mimetic.Abstract Reactive oxygen species (ROS)-induced ROS release (RIRR) is a fundamental mechanism by which cardiac mitochondria respond to elevated ROS levels by stimulating endogenous ROS production in a regenerative, autocatalytic process that ultimately results in global oxidative stress (OS), cellular dysfunction and death. Despite elegant studies describing the phenomenon of RIRR under artificial conditions such as photo-induced oxidation of discrete regions within cardiomyocytes, the existence, biophysical properties and functional consequences of RIRR in intact myocardium remain unclear. Here, we used a semi-quantitative approach of optical superoxide (O 2 − ) mapping using dihydroethidium (DHE) fluorescence to explore RIRR, its arrhythmic consequences and underlying mechanisms in intact myocardium. Initially, perfusion of rat hearts with 200 μM H 2 O 2 for 40 min (n = 4) elicited two distinct O 2 − peaks that were readily distinguished by their timing and amplitude. The first peak (P1), which was generated rapidly (within 5-8 min of H 2 O 2 perfusion) was associated with a relatively limited (10 ± 2%) rise in normalized O 2 − levels relative to baseline. In contrast, the second peak (P2) occurred 19-26 min following onset of H 2 O 2 perfusion and was associated with a significantly greater amplitude compared to P1. Spatio-temporal ROS mapping during P2 revealed active O 2 − propagation across the myocardium at a velocity of ∼20 μm s −1 . Exposure of hearts (n = 18) to a short (10 min) episode of H 2 O 2 perfusion revealed consistent generation of P2 by high (≥200 μM, 8/8) but not lower (≤100 μM, 3/8) H 2 O 2 concentrations (P < 0.03). In these hearts, onset of P2 occurred following, not during, the 10 min OS protocol, consistent with RIRR. Importantly, P2 (+) hearts exhibited a markedly greater (by 3.8-fold, P < 0.001) arrhythmia score compared to P2 (-) hearts. To explore the mechanism underlying RIRR in intact myocardium, hearts were perfused with either cyclosporin A (CsA) or 4 -chlorodiazepam (4 -Cl-DZP) to inhibit the mitochondrial permeability transit...