Since the introduction of percutaneous epicardial access for the purpose of mapping and ablation of cardiac arrhythmias, this technique has become an important adjunct and at times the preferred approach to treat certain cardiac arrhythmias. In addition, this approach is currently also being considered for a number of other cardiovascular applications such as epicardial pacing, left atrial appendage ligature occlusion, etc. The focus of this review is to discuss relevant aspects of pericardial anatomy, and various methods of epicardial access.