This article discusses the role of age in patients with heart failure who receive cardiac implantable electronic devices (CIEDs). The study, based on a large nationwide cohort in Sweden, aimed to investigate age-adjusted survival and the risk of heart failure hospitalization in patients with prior heart failure who received a CIED with a right ventricular (RV) lead. The study found that overall mortality was highest in patients treated with single-chamber pacemakers, while the risk of heart failure hospitalization within 5 years was highest in patients treated with cardiac resynchronization therapy (CRT). The study also highlighted the underuse of CRT and ICD upgrades in Sweden. The article suggests that proper selection of the CIED type during the initial procedure is important to reduce the burden of right ventricular pacing. Additionally, left bundle branch pacing (LBBP) was found to have better outcomes compared to conventional right ventricular pacing. The study acknowledges limitations in terms of missing data on certain variables and calls for further randomized studies.