Interoceptive accuracy, the ability to correctly perceive internal bodily signals, is considered integral to emotional experience. However, surprising evidence suggests that whilst females tend to have poorer interoceptive accuracy than males, they tend to have better emotion processing ability and rate their emotional competence higher. The current systematic review and meta-analysis aimed to investigate sex differences in the relationship between cardiac interoceptive accuracy and emotion. A review of three databases (PsychInfo, Web of Science, PubMed) yielded 2707 abstracts, resulting in 94 eligible studies. Authors of eligible studies were contacted for sex disaggregated summary statistics. 33 and 30 studies were included in the qualitative and quantitative synthesis, respectively. Overall, we found little evidence of a relationship between cardiac interoceptive accuracy and measures of emotion when examining pooled groups and after sex disaggregation. These results question the proposal that cardiac interoceptive accuracy, as routinely measured, relates to emotion. The implications of these results are discussed considering limitations of our current measures of cardiac interoceptive accuracy and emotion.