Successful uncomplicated transeptal access was achieved under fluoroscopic and intracardiac echocardiographic guidance. Unfractionated IV heparin was administered to obtain an activating clotting time between 240 and 280 s throughout the procedure. Two cryoballoon applications (300 s each) were delivered to the antrum of each pulmonary vein (Arctic Front; Medtronic CryoCath LP; 28 mm cryoballoon) (Fig 1). The nadir temperatures reached were −70°C in the left superior pulmonary vein, −73°C in the left inferior pulmonary vein (LIPV), −56°C in the right superior pulmonary vein, and −48°C in the right inferior pulmonary vein; in the latter, the ablation was stopped prematurely (220 s) due to transient phrenic palsy. Isolation of the four veins was confirmed using a circular mapping catheter. Protamine was administered to reverse heparin effect. Twenty-four hours after the procedure, the patient complained of cough and blood-tinged sputum. A chest CT scan showed a condensation pattern compatible with the diagnosis of pulmonary hemorrhage near the lingular bronchus, in close proximity to the LIPV (Fig 2). A bronchoscopic evaluation did not demonstrate active bleeding, showing only mucosal petechial instrument-related lesions (Fig 3). During the following days, the cough and blood-tinged sputum ceased, and the patient was discharged. The patient remained asymptomatic during follow-up.