BACKGROUND Although infection is a serious complication of pacemaker implantation, optimal treatment of infections related to pacemaker systems is poorly defined. METHODS We describe a man in his 60s, an octogenarian, and two nonagenarian females who were treated for an infected permanent pacemaker. All of these patients developed inflammation that presented as local symptoms and purulent collection in the pockets of their implanted pacemakers. After fenestration of the pacemaker pockets, they were treated with vacuum-assisted wound closure (VAC). RESULTS Infection was eradicated in all the patients without the need for aggressive surgery. The open wound was re-sutured without complete removal of the pacemaker system in two patients. After removing the infected generator from the other two patients, the open wounds healed with or without re-suture. The mean duration of VAC was 19.5 days. The postoperative course of all of the patients was uneventful, and they remained completely asymptomatic after VAC, with no evidence of recurrent infection for 5- 15 months after discharge. CONCLUSIONS When the risk of total system explantation is high, less-invasive VAC might serve as the option for treating an infected pacemaker. (PACE 2010; 426-430).