Aiming at the demand for passive sonar systems for medium and low-frequency detection, low cost, and small working platform working sensor, a three-axis pressure piezoelectric accelerometer based on piezoelectric ceramic fiber is designed. Firstly, based on the acoustic vibration pick-up principle and extended Hamilton, the action mode of the accelerometer is analyzed theoretically to determine the accelerometer structure size. The accelerometer with a special mass structure is designed by using axially polarized piezoelectric ceramic fiber. The characteristic frequency and frequency domain analysis of the accelerometer are simulated by the FEM method. The results show that the overall size of the piezoelectric accelerometer is 20 mm ×20 mm×35 mm, the first-order natural frequency is 410 Hz, the external field directivity is standard “8” type, and the acceleration sensitivity reaches 112.2 mV/g, which verifies the great potential of the three-axis accelerometer designed by piezoelectric ceramic fiber material in the field of medium and low frequency.