Mitochondrial Ca2+ efflux via mPTP opening increases Ca2+ wave generation. Mitochondrial Ca2+ efflux promotes Ca2+ alternans in single cells. mPTP inhibition reduces the Ca2+ wave rate and incidence of Ca2+ alternans. Ca2+ efflux via mPTP is likely involved in FCCP- and I/R-induced arrhythmias. mPTP inhibition reduces susceptibility to FCCP and I/R-induced arrhythmias.