The elongated access sleeve 10 provides an working lumen 18 enabling introduction of a cutting instrument 80, e.g., a knife, a needle, a stiff guidewire tip, an electrosurgical cutting tool, surgical scissors, or other piercing or cutting instrument, to first perforate the pericardium 106 and then form an access hole or perforation 114 exposing the pericardial space and exterior surface of the epi