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Background  Circulatory dynamics change during pulmonary vein (PV) isolation using cryoballoons. This study sought to investigate the circulatory dynamics during cryoballoon‐based PV isolation procedures and the contributing factors.    Methods and Results  This study retrospectively included 35 atrial fibrillation patients who underwent PV isolation with 28‐mm second‐generation cryoballoons and single 3‐minute freeze techniques. Blood pressures were continuously monitored via arterial lines. The left ventricular function was evaluated with intracardiac echocardiography throughout the procedure in 5 additional patients. Overall, 126 cryoapplications without interrupting freezing were analyzed. Systolic blood pressure ( SBP ) significantly increased during freezing (138.7±28.0 to 148.0±27.2 mm Hg,  P <0.001) and sharply dropped (136.3±26.0 to 95.0±17.9 mm Hg,  P <0.001) during a mean of 21.0±8.0 seconds after releasing the occlusion during thawing. In the multivariate analyses, the left  PV s ( P =0.008) and lower baseline  SBP  ( P <0.001) correlated with a larger  SBP  rise, whereas a higher baseline  SBP  ( P <0.001), left  PV s ( P =0.017), lower balloon nadir temperature ( P =0.027), and female sex ( P =0.045) correlated with larger  SBP  drops. These changes were similarly observed regardless of preprocedural atropine administration and the target  PV  order.  PV  occlusions without freezing exhibited no  SBP  change.  PV  antrum freezing without occlusions similarly increased the  SBP , but the  SBP  drop was significantly smaller than that with occlusions ( P <0.001). The  SBP  drop time‐course paralleled the left ventricular ejection fraction increase (66.8±8.1% to 79.3±6.7%,  P <0.001) and systemic vascular resistance index decrease (2667±1024 to 1937±513 dynes‐sec/cm 2  per m 2 ,  P =0.002).    Conclusions  With second‐generation cryoballoon‐based PV isolation,  SBP  significantly increased during freezing owing to atrial tissue freezing and dropped sharply after releasing the occlusion, presumably because of the peripheral vascular resistance decrease mainly by circulating chilled blood.

Circulatory Dynamics During Pulmonary Vein Isolation Using the Second‐Generation Cryoballoon