There is an exponential growth in the need for percutaneous epicardial access, which may be helpful for left atrial appendage closure, catheter ablation, and other emerging percutaneous cardiovascular treatments, as well as for managing procedural complications. It is important that percutaneous access procedures are completed safely and effectively. To do so it is necessary to have a complete understanding of procedural indications and contraindications, the pertinent anatomy, and the tools and options available. Focused, brief lectures, illustrative recorded cases, and an expert panel discussion will be presented to demonstrate key points with fluoroscopic, transthoracic, and intracardiac echocardiographic images. At the conclusion of this review, the participant will have a firm understanding of the anatomy of the heart and pericardium, when access is clinically needed, and how to safely obtain it.