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In cardiac resynchronization therapy (CRT), positive clinical response and reverse remodeling have been reported using robotically assisted left ventricular (LV) epicardial lead placement. However, the long-term performance of epicardial leads and long-term outcome of patients who undergo CRT via robotic assistance are unknown. In addition, since the LV lead placement is more invasive than a transvenous procedure, it is important to identify patients at higher risk of complications.We evaluated 78 consecutive patients (70 ± 11 years, 50 male) who underwent robotic epicardial LV lead placement. The short- (12 months) and long-term (≥ 12 months) lead performance was determined through device interrogations. Mortality data were determined by contact with the patient's family and referring physicians and confirmed using the Social Security Death Index.All patients had successful lead placement and were discharged in stable condition. When compared to the time of implantation, there was a significant increase in pacing threshold (1.0 ± 0.5 vs 2.14 ± 1.2; P0.001) and decrease in lead impedance (1010 ± 240 Ω vs 491 ± 209 Ω; P0.001) at short-term follow-up. The pacing threshold (2.3 ± 1.2 vs 2.14 ± 1.2; P = 0.30) and lead impedance (451 ± 157 Ω vs 491 ± 209 Ω; P = 0.10) remained stable during long-term follow-up when compared to short-term values. At a follow-up of 44 ± 21 months, there were 20 deaths (26%). These patients were older (77 ± 7 vs 67 ± 11 years; P = 0.001) and had a lower ejection fraction (EF) (13 ± 7% vs 18 ± 9%; P = 0.02) than surviving patients.Robotically implanted epicardial LV leads for CRT perform well over short- and long-term follow-up. Older patients with a very low EF are at higher risk of death. The risks and benefits of this procedure should be carefully considered in these patients.