Heart rate variability (HRV) is a psychophysiological measure of particular interest in esports due to its potential to monitor player self-regulation. This study aimed to systematically review the utilisation of HRV in esports. Consideration was given to the methodological and theoretical underpinnings of previous works to provide recommendations for future research. The protocol was made available on the Open Science Framework. Inclusion criteria were empirical studies, examining HRV in esports, using esports players, published in English. Exclusion criteria were non-peer-reviewed studies, populations with pre-existing clinical illness other than Internet Gaming Disorder (IGD), opinion pieces or review papers. In November 2022 a search of Web of Science, PubMed and EBSCOHost identified seven studies using HRV in esports. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Narrative review identified two primary uses of HRV, investigating stress response and IGD in esports. A lack of theoretical and methodological underpinning was identified as a major limitation of current literature. Further investigation is necessary before making recommendations regarding the use of HRV in esports. Future research should employ sound theoretical underpinning such as the use of vagally mediated HRV and the robust application of supporting methodological guidelines when investigating HRV in esports.