Systematic review and meta-analysis of the relationship between the heartbeat-evoked potential and interoception

Author: Michel-Pierre Coll1, Hannah Hobson2, Geoffrey Bird3, Jennifer Murphy4
1 Department of Psychology, McGill University, 2001 McGill College, Montreal, H3A1G1, Canada. Electronic address:
2 Department of Psychology, University of York, York, YO10 5DD, UK. Electronic address:
3 Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2, UK. Electronic address:
4 Department of Psychology, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK. Electronic address:
Conference/Journal: Neurosci Biobehav Rev
Date published: 2021 Mar 1
Other: Volume ID: 122 , Pages: 190-200 , Special Notes: doi: 10.1016/j.neubiorev.2020.12.012. , Word Count: 245

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.

Keywords: HEP; Heartbeat evoked potential; Interoceptive accuracy; Meta-analysis.

PMID: 33450331 DOI: 10.1016/j.neubiorev.2020.12.012