Epicardial fat is closely related to blood supply vessels, both anatomically and functionally, which is why any change in this adipose tissue's behavior is considered a potential risk factor for cardiovascular disease development.1) Epicardial fat is a white adipose tissue storage fat that cover 80% of the heart's surface, representing 20% of the organ's total weight. Adipose tissue is a biologically active organ regulating the metabolism of neighboring organs. It is also a major source of cytokines and hormones, acting as a localized gland. In the heart, epicardial adipose tissue is contiguous with the myocardium without fascia boundaries resulting in paracrine effects through the release of adipokines.2) The close anatomic relationship of epicardial adipose tissue to the adjacent myocardium suggests possible local interactions between these tissues. Epicardial fat in states of positive energy balance, when the free fatty acids (FFA) in the blood are converted into triglycerides and accumulated initially in adipocytes and then in nonfat cells. Magnetic resonance and spectroscopy have demonstrated the strong correlation between epicardial fat volume and triglyceride concentration in the myocardium.3) Under physiologic conditions, epicardial adipose tissue is thought to act as a buffering system against toxic levels of fatty acids between the myocardium and the local vascular bed. Thus, increased epicardial fat could scavenge excess fatty acids, which interfere with the generation and propagation of the contractile cycle of the heart, causing ventricular or atrial arrythmias and alterations in repolarization. Recently, a relationship between the thickness of epicardial adipose tissue and the incidence and severity of atrial fibrillation (AF) has been reported.4) However, the potential association between epicardial fat thickness (EFT) and plasma FFA level in ischemic stroke with or without AF has not been previously investigated.