Systematic review and meta-analysis of the relationship between the heartbeat-evoked potential and interoception
Open accessAbstract
The Heartbeat Evoked Potential (HEP) has been proposed as a neurophysiological marker of interoceptive processing. Despite its use to validate interoceptive measures and to assess interoceptive functioning in clinical groups, the empirical evidence for a relationship between HEP amplitude and interoceptive processing, including measures of such processing, is scattered across several studies with varied designs. The aim of this systematic review and meta-analysis was to examine the body of HEP-interoception research, and consider the associations the HEP shows with various direct and indirect measures of interoception, and how it is affected by manipulations of interoceptive processing. Specifically, we assessed the effect on HEP amplitude of manipulating attention to the heartbeat; manipulating participants' arousal; the association between the HEP and behavioural measures of cardiac interoception; and comparisons between healthy and clinical groups. Following database searches and screening, 45 studies were included in the systematic review and 42 in the meta-analyses. We noted variations in the ways individual studies have attempted to address key confounds, particularly the cardiac field artefact. Meta-analytic summaries indicated there were moderate to large effects of attention, arousal, and clinical status on the HEP, and a moderate association between HEP amplitude and behavioural measures of interoception. Problematically, the reliability of the meta-analytic effects documented here remain unknown, given the lack of standardised protocols for measuring the HEP. Thus, it is possible effects are driven by confounds such as cardiac factors or somatosensory effects.
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Cardiac parameters themselves such as heart rate or stroke volume seem to have only a limited influence on HERs' variability.
“So far, cardiac parameters themselves such as heart rate or stroke volume seem to have only a limited influence on HERs' variability 79-81 .”
From Interoceptive rhythms in the brain (2023) · cites this paper as [81]
Section 5.4 (page unavailable) says the review's findings support the suggestion that HEPs partly reflect cardiac dynamics, and that arousal manipulations—which change cardiac dynamics—had the largest effect on HEPs. Section 5.3 reports a large effect of arousal on HEP amplitude. The paper does not isolate heart rate or stroke volume, but its assessment of cardiac dynamics is contrary to describing their influence as only limited. (LLM, conf=0.82)
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Experimental — accuracy not yet measuredMost research to date has been based on neuroanatomical correlates with fMRI or studying the heart-evoked potential (HEP).
“Most research to date, however, has been based on neuroanatomical correlates with fMRI or studying the heart-evoked potential (HEP).6, 7, 8”
From Altered spatiotemporal brain dynamics of interoception in behavioural-variant frontotemporal dementia (2025) · cites this paper as [6]
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- Authors
- Coll, M.-P., Hobson, H., Bird, G., & Murphy, J.
- Affiliations
- McGill University (CA)
- University of York (GB)
- University of Oxford (GB)
- Royal Holloway University of London (GB)
- Corresponding author
- Coll, Michel-Pierre
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 122
- Pages
- 190-200
- ISSN
- 0149-7634 (ISSN-L)
- OpenAlex
- W3112896572
- Cited by
- 262
- References
- 89
- Citations by year
- 2026: 45 · 2025: 66 · 2024: 60 · 2023: 42 · 2022: 29 · 2021: 20
- FWCI
- 6.74
- Type
- journal article
- Language
- en
- Open access
- green
- orcid.org
- Licence
- Locations
- Neuroscience & Biobehavioral Reviews (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion, other-oa)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- Canadian Institutes of Health Research
- Economic and Social Research Council (ES/R007527/1)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Keywords
- heartbeat-evoked potentials, interoception, cardiac interoception, arousal, clinical groups
- MeSH terms
- Arousal, Awareness, Evoked Potentials, Heart Rate, Humans, Reproducibility of Results, Interoception
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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