Sudden cardiac death (SCD) is responsible for almost 50% of all cardiac deaths in the U.S. The most common underlying cause of SCD is coronary artery disease, especially acute myocardial infarction (AMI). There are no publications concerning the shape of ST segment elevation in AMI and the risk of ventricular fibrilation (VF) or SCD. We present three cases with AMI and atypical ST segment elevation - 'lambda-wave-like' pattern, complicated with episodes of VF. This ECG pattern resembles the ST segment elevation shape in the type 1C Brugada syndrome. The 'lambda-like' ST segment elevation in AMI may identify patients with increased risk of VF or SCD.