The impact of the boreal summer intraseasonal oscillation (BSISO) on extreme hot and cool events was investigated, by analyzing the observed and reanalysis data for the period from 1983 to 2012. It is found that the frequency of the extreme events in middle and high latitudes is significantly modulated by the BSISO convection in the tropics, with a 3–9-day lag. During phases 1 and 2 when the BSISO positive rainfall anomaly is primarily located over a northwest–southeast oriented belt extending from India to Maritime Continent and a negative rainfall anomaly appears in western North Pacific, the frequency of extreme hot events is 40% more than the frequency of non-extreme hot events. Most noticeable increase appears in midlatitude North Pacific (north of 40°N) and higher-latitude polar region. Two physical mechanisms are primarily responsible for the change of the extreme frequency. First, an upper-tropospheric Rossby wave train (due to the wave energy propagation) is generated in response to a negative heating anomaly over tropical western North Pacific in phases 1 and 2. This wave train consists of a strong high pressure anomaly center northeast of Japan, a weak low pressure anomaly center over Alaska, and a strong high pressure anomaly center over the western coast of United States. Easterly anomalies to the south of the two strong midlatitude high pressure centers weaken the climatological subtropical jet along 40°N, which is accompanied by anomalous subsidence and warming in North Pacific north of 40°N. Second, an enhanced monsoonal heating over South Asia and East Asia sets up a transverse monsoonal overturning circulation, with large-scale ascending (descending) anomalies over tropical Indian (Pacific) Ocean. Both the processes favor more frequent extreme hot events in higher-latitude Northern Hemisphere. An anomalous atmospheric general circulation model is used to confirm the tropical heating effect.