Nowadays the study of Net Zero Energy Buildings (NZEBs) is fundamental, because they are the main strategy to reduce the building energy demand and CO2-equivalent emissions. This paper analyses a case study concerning a multipurpose building located in Palermo (Southern Italy), and evaluates the benefits related to the use of an earth-to-air heat exchanger in a NZEB, in terms of energy saving and reduction of CO2-equivalent emissions, for a Mediterranean climate. The chosen building envelope is thermally performing. The HVAC system consists in fan-coil units connected to an air-to-water heat pump, and mechanical ventilation. The energy demand is reduced by an earth-to-air heat exchanger that pre-heats the ventilation outside air in wi...