Devices and methods are disclosed for providing access to the pericardial cavity while reducing risk of myocardial damage. One method includes advancing a puncture device towards a heart, the puncture device including an energy delivery device； measuring an electrical impedance at the energy delivery device； delivering energy from the energy delivery device to at least partially puncture a pericardium； and repeating one or more of the above steps, if necessary, until the energy delivery device is located at least partially within the pericardial cavity. Some embodiments of the method include using supplemental means of monitoring, including measuring voltage to plot an ECG, medical imaging and using contrast fluid, using tactile feedback, and aspirating fluid.
