Heartbeat evoked potential and spectral analysis in patients with panic disorder during resting state

Panic disorder (PD) involves recurrent panic attacks and anticipatory anxiety, with interoceptive dysfunction potentially contributing to its pathophysiology. This study analyzed differences in heartbeat evoked potential (HEP) and spectral power between 19 PD patients and 21 HCs during eyes-closed (EC) and eyes-open (EO) conditions to assess interoceptive processing and cortical arousal patterns. Key findings showed: (1) Compared to healthy controls, panic disorder patients exhibited higher interoceptive attention scores (BPQ-VSF: t = -4.944, p < .001; noticing: t = -1.156, p = .255), greater interaction between interoception and emotion (not-worrying: t = 4.487, p < .001; emotional awareness: Z = 2.009, p = .004), greater difficulty in regulating attention to maladaptive interoceptive signals (not distracting: t = 2.504, p = .017), and lower sense of safety and trust in the body (trusting: t = -2.858, p = .004); (2) PD patients exhibited reduced HEP amplitudes in left parieto-occipital regions during EC compared to HCs; (3) Spectral analysis revealed increased beta-band power in PD patients during EC (t = -0.804, p < .05), further elevated during EO (t = -0.553, p < .001) - a pattern absent in HCs. These results demonstrate impaired interoceptive regulation (diminished HEP modulation) and cortical hyperarousal (elevated beta oscillations) in PD. The study provides novel electrophysiological evidence for PD's neuropathology, identifying interoception-arousal dysregulation as a potential treatment target.