David S Frankel
VerifiedUniversity of Pennsylvania · Rehabilitation Medicine
Active 1945–2026
About
David S Frankel, MD, is a Professor of Medicine in the Department of Cardiovascular Medicine at the Hospital of the University of Pennsylvania. He is also an Attending Physician at the same hospital and serves as the Director of the Cardiac Electrophysiology Laboratories. Dr. Frankel's clinical expertise includes ventricular tachycardia, atrial fibrillation, catheter ablation, supraventricular tachycardia, pacemakers (including leadless), defibrillators (including subcutaneous and extravascular), cardiac resynchronization therapy, conduction system pacing, and left atrial appendage closure (Watchman). His research focuses on ventricular tachycardia, atrial fibrillation, catheter ablation, pacing-induced cardiomyopathy, and cardiac resynchronization therapy. Dr. Frankel has contributed to numerous publications in the field of cardiac electrophysiology, advancing understanding and treatment of complex arrhythmias.
Research topics
- Internal medicine
- Medicine
- Cardiology
- Biochemistry
- Chemistry
- Virology
- Surgery
- Chromatography
Selected publications
PO-04-064 ANATOMICAL APPROACH FOR SLOW PATHWAY ABLATION USING INTRACARDIAC ECHOCARDIOGRAPHY
Heart Rhythm · 2026-04-01
articleCirculation Arrhythmia and Electrophysiology · 2026-04-22
articleCirculation Arrhythmia and Electrophysiology · 2026-04-20 · 1 citations
articleSenior authorBACKGROUND: The subcutaneous implantable cardioverter defibrillator (S-ICD) offers protection from sudden cardiac death without transvenous leads. Although contemporary techniques and programming have reduced inappropriate shocks, high rates persist in certain populations. The objective of this study was to evaluate the impact of a novel quantitative vector screening (QVS) protocol on the incidence of sensing-related complications and inappropriate shocks in patients undergoing S-ICD implantation. METHODS: We analyzed 223 consecutive patients who underwent S-ICD implantation at the Hospital of the University of Pennsylvania from December 2018 to July 2025. Traditional vector screening was used before 2023. In 2023, we implemented QVS, which incorporated quantitative sensing scores for each candidate and raised the threshold for S-ICD implantation. The primary end point was time to first inappropriate shock or under-sensed ventricular arrhythmia. Secondary outcomes included SMART Pass deactivation and need for device revision. Outcomes were reported as survival analyses. RESULTS: During preimplant screening, the QVS protocol reduced patient eligibility from 96% to 83%. The median follow-up after implant was 42 months (interquartile range, 48) in the traditional vector screening arm and 18 months (interquartile range, 15) in the QVS arm. The primary end point of time to first inappropriate shock or under-sensed ventricular arrhythmia was longer in the QVS arm (log-rank, P =0.02). There were 23 primary end point events among 145 patients in the traditional vector screening arm (5.2 per 100 patient-years [95% CI, 3.1–7.4]) and 2 primary end point events among 78 patients in the QVS arm (1.8 per 100 patient-years [95% CI, 0.01–4.38]). CONCLUSIONS: Implementation of a novel S-ICD screening protocol with stricter eligibility thresholds reduced sensing-related complications, particularly inappropriate shocks.
Heart Rhythm · 2025-05-22 · 1 citations
articlemedRxiv · 2025-09-19
preprintOpen accessAbstract Importance Mavacamten is highly effective in treating symptomatic obstructive hypertrophic cardiomyopathy (oHCM) and was approved for commercial use with a risk mitigation program (REMS) to monitor the impact on left ventricular systolic function (LVSD). The impact of mavacamten on atrial fibrillation (AF) occurrence is not well characterized. Objective Determine the real-world incidence of new-onset and recurrent AF among patients with HCM treated with commercial mavacamten. Secondary objectives included assessing the incidences of LVSD, heart failure (HF), and cardiogenic shock. Design A multicenter cohort study. Center-level data were aggregated for patients who received mavacamten from May 2022 through December 2024. Setting Twenty-one outpatient HCM centers in the United States. Participants Consecutive patients ≥18 years of age with oHCM were included; those with permanent AF were excluded. Exposures At least one dose of commercial mavacamten. Main Outcomes and Measures Incidence of new-onset and recurrent AF, LVSD, HF, and cardiogenic shock. Results Among 1,538 patients (median age, 66 years [95% CI, 65.9–66.1]; 57% female [95% CI, 54–59%]), 25% [95% CI, 22-27%] had prior AF. Median mavacamten exposure was 13.4 months [95% CI, 11.8–15.0]. Overall AF incidence was 13% [95% CI, 10–17%], including 5% [95% CI, 4–7%] new-onset and 39% [95% CI, 27–51%] recurrent AF in those with history of AF prior to mavacamten initiation. LVEF <50% occurred in 8% [95% CI, 6–9%], of whom 70% had AF. Symptomatic HF occurred in 1.5% [95% CI, 0.8–2.2%], cardiogenic shock in 0.6% [95% CI, 0.1–1.0%], and an overall permanent discontinuation of mavacamten in 7% [95% CI, 4–10%]. Conclusions and Relevance In this multicenter cohort receiving commercial mavacamten, we identified an annual incidence of 5% new-onset AF and 39% recurrent AF, while 70% of patients who developed LVEF<50% had concurrent AF. Given this association and the morbidity that can be associated with AF, protocols for LVEF assessment and aggressive rhythm management following AF detection may be warranted to improve patient care. Further studies are needed to improve understanding of the impact of mavacamten on AF and patient outcomes. Key points Question What are the real-world burden and consequences of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy treated with commercial mavacamten? Findings In a multicenter cohort of more than 1,500 patients, 5% experienced new-onset AF, while 39% of those with pre-existing AF experienced recurrence after mavacamten initiation. Left ventricular ejection fraction (LVEF) fell below 50% in 8% of patients, 70% of whom had concurrent AF. Meaning Real-world experience with mavacamten emphasizes that regular surveillance for AF is an important aspect of managing patients with HCM. Additionally, the identification of AF should prompt LVEF assessment and aggressive rhythm management, given the potential association between AF and decrease in LVEF. The observed incidence of AF on mavacamten highlights the need for further studies on potential mechanisms and for proactive surveillance and management strategies.
International Journal of Radiation Oncology*Biology*Physics · 2025-09-01
articleOpen accessLeft Bundle Branch Area Pacing in Patients With Cardiac Sarcoidosis
JACC. Clinical electrophysiology · 2025-11-20 · 2 citations
articleHRS Scientific Documents Methodology Manual: Executive summary
Heart Rhythm · 2025-06-03
review1st authorCorrespondingLead Implantation in the Setting of Venous Occlusion
JACC. Clinical electrophysiology · 2025-06-18 · 1 citations
articleOpen accessSenior authorCirculation · 2025-11-03
articleBackground: Patients with left ventricular assist devices (LVADs) may develop ventricular tachycardia (VT) refractory to conventional antiarrhythmic strategies. Catheter ablation is associated with increased procedural risks in this population and may be less effective, especially when critical substrate is epicardial or near the LVAD cannula. Cardiac stereotactic body radiotherapy (SBRT) has emerged as a promising therapy for patients with VT refractory to antiarrhythmic drugs (AADs) and catheter ablation. However, clinical data on SBRT in patients with LVADs remain limited. Objective: To evaluate the safety and efficacy of cardiac SBRT in managing refractory VT in patients with durable LVAD support. Methods: We conducted a retrospective review of all patients with existing LVADs who underwent SBRT (25 Gy) for drug- and ablation-refractory VT at our institution. All patients had previously failed conventional therapies. Clinical outcomes, including VT recurrence, implantable cardioverter defibrillator (ICD) therapies, ventricular function, complications, and survival, were assessed over a follow-up period ranging from 3 to 28 months. Results: Four patients met inclusion criteria (see Table). Three experienced VT recurrence: one within the first month and two within two months post-SBRT. One of these recurrences resulted in an ICD shock. One patient has remained arrhythmia-free for 14 months post-treatment. Importantly, no patients experienced LVAD-related complications attributable to SBRT. Post-treatment echocardiographic assessment revealed no significant changes in left or right ventricular function. Three patients died during follow-up at 3, 17, and 22 months. Only one death was directly attributed to refractory VT; the remaining two were due to hypoxic respiratory failure and septic shock. Conclusion: In this small series, cardiac SBRT appeared safe and potentially beneficial for patients with LVADs and refractory VT. Although most patients experienced recurrent VT, SBRT may delay recurrence in selected high-risk individuals. One patient achieved sustained arrhythmia suppression. These findings support further investigation of SBRT as a non-invasive adjunctive therapy in this challenging population.
Frequent coauthors
- 318 shared
Francis E. Marchlinski
- 246 shared
David J. Callans
University of Pennsylvania
- 184 shared
Pasquale Santangeli
Cleveland Clinic
- 169 shared
Robert D. Schaller
- 162 shared
Gregory E. Supple
University of Pennsylvania
- 157 shared
David Lin
Hospital of the University of Pennsylvania
- 145 shared
Fermin C. García
- 130 shared
Sanjay Dixit
University of Pennsylvania
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