Apparatuses and methods for the perforation of heart tissue of a patient when an inferior approach to the heart is contraindicated are disclosed. The method includes using a superior approach to introduce the apparatus, positioning the apparatus at a tissue location and delivering a controlled amount of non-mechanical energy to the tissue to create a perforation. For example, a method of surgical perforation via the delivery of electrical, radiant or thermal energy may include: introducing an apparatus comprising an energy delivery device into a patients heart via the patients superior vena cava positioning the energy delivery device at a first location adjacent material to be perforated and perforating the material by delivering energy via the energy delivery device wherein the energy is selected from the group consisting of electrical energy, radiant energy and thermal energy.
