BACKGROUND: This review aimed to evaluate whether patients with panic disorder (PD) exhibit different heart rate variability (HRV) compared to healthy controls and to determine whether HRV is different in patients with PD after treatment. METHODS: Literature databases were searched for studies comparing resting-state HRV between drug-naive patients with PD and healthy controls. Parameters from the short-term frequency-domain and long-term time domain were included. RESULTS: In the low frequency (LF) analysis, no significant association was found between LF and PD (standardised mean difference [SMD] = -0.0443, 95% confidence interval [CI]: -0.1765 to 0.0879). In the high frequency (HF) analysis, no significant association was found between HF and PD (SMD = -0.1269, 95% CI: -0.2598 to 0.0059). In the LF/HF analysis, a significantly higher LF/HF ratio was found in cases than in controls, but the effect was moderate (SMD = 0.1390, 95% CI: 0.0180 to 0.2600). For the standard deviation of normal-to-normal intervals, a significantly lower value was observed in cases than in controls (SMD = -0.3133, 95% CI: -0.5459 to -0.0808). LIMITATIONS: Limited sample size in the time-domain and treatment effect analyses. CONCLUSIONS: Patients with PD had a higher short-term LF/HF ratio, indicating impaired sympathovagal balance. The LF/HF ratio findings were more consistent compared with LF and HF alone, making it a better parameter to interpret the LF and HF in conjunction. HRV may be a promising biomarker for predicting antidepressant response.