A recently developed space-time adaptive mesh refinement algorithm (AMRA) for simulating isotropic one- and two-dimensional excitable media is generalized to simulate three-dimensional anisotropic media. The accuracy and efficiency of the algorithm is investigated for anisotropic and inhomogeneous 2D and 3D domains using the Luo-Rudy 1 (LR1) and FitzHugh-Nagumo models. For a propagating wave in a 3D slab of tissue with LR1 membrane kinetics and rotational anisotropy comparable to that found in the human heart, factors of 50 and 30 are found, respectively, for the speedup and for the savings in memory compared to an algorithm using a uniform space-time mesh at the finest resolution of the AMRA method. For anisotropic 2D and 3D media, we find no reduction in accuracy compared to a uniform space-time mesh. These results suggest that the AMRA will be able to simulate the 3D electrical dynamics of canine ventricles quantitatively for 1 s using 32 1-GHz Alpha processors in approximately 9 h. © 2003 American Institute of Physics.