Background: Cerebrovascular disease is the second most common cause of death after coronary artery disease (CAD) and remains a major health problem worldwide. Cardioembolic stroke is the most common predicted cause of cryptogenic stroke, and atrial fibrillation (AF) is the most frequent cause of cerebral cardio-embolism. Objective: The aim of this study was to evaluate the performance of epicardial fat thickness (EFT) as a risk factor of acute ischemic stroke in patients with AF. Patients and Methods: This was a case-control study at Cardiology Department, Zagazig University Hospitals and Nasser Institute for Research and Treatment, conducted on 60 patients: (20) AF patients with acute ischemic stroke (AIS), (20) AF patients without AIS and (20) controls without AF or AIS. Results: The current study showed that, AF patients with AIS have mean of age (66.15± 9.12). Our recent study revealed that, males with AF with AIS were more than females (65.0%; 35.0% respectively). The current study showed that, there were statistically significant difference between the studied groups regarding smoking and hypertension (HTN). Regarding echo finding, mean value of EFT was statistically higher among AF patients with AIS than AF patients without AIS. Mean value of EFT was statistically higher among AF patients with AIS than controls group. Mean value of EFT was statistically higher among AF patients without AIS than controls group. Conclusion: EFT is an independent predictor for the development of acute ischemic stroke in patients with AF.