Special Interview with Reviews in Cardiovascular Medicine Editorial Board Member Associate Prof. Alessandro Zorzi: Insights into Sports Cardiology, Athlete’s Bradycardia, and the Future of Cardiovascular Screening

29 May 2026

We are honored to have invited Associate Professor Alessandro Zorzi from the University of Padova, Padua, Italy, to join us for this special interview. Professor Zorzi serves as an Editorial Board Member of Reviews in Cardiovascular Medicine (RCM) and was also a Guest Editor of our special issue on Arrhythmogenic Cardiomyopathy: Current Updates and Future Challenges. He is an Associate Professor of Cardiology at the Department of Cardio‑Thoraco‑Vascular Sciences and Public Health, University of Padova, Padua, Italy. His main research interests include sports cardiology, sudden cardiac death, ventricular arrhythmias, arrhythmogenic cardiomyopathy, and cardiac arrest in athletes. He has published several high‑quality papers in RCM, including a notable study in November 2025 on intrinsic versus extrinsic sinus and atrioventricular node dysfunction in athletes. The purpose of this interview is to share Professor Zorzi’s thoughtful insights in the field of sports cardiology with our readers, strengthen the interaction between the journal and its editorial board members, and further promote academic exchange in cardiovascular medicine. It is a great pleasure and honor to have this conversation with Dr. Zorzi.

	Alessandro Zorzi, MD, PhD, FESC
	Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
	Interests: sports cardiology; sudden death; ventricular arrhythmias; athletes; arrhythmogenic cardiomyopathy; cardiac arrest

1. Could you briefly introduce your academic background, your current research areas, and the main scientific work you are currently focusing on?

I am currently an Associate Professor of Cardiology at the University of Padua in Italy. My primary research field is sports cardiology, with a particular focus on arrhythmias and cardiovascular diseases that may lead to sudden cardiac death in athletes. Over the past decade, my research has mainly centered on understanding the mechanisms, diagnosis, and prevention of these potentially life-threatening cardiac conditions.

2. In November 2025, you published a study in our journal entitled Intrinsic Versus Extrinsic Sinus and Atrioventricular Nodes Dysfunction in Athletes: Insights From Transesophageal Electrophysiological Testing With Autonomic Blockade. Could you share with us the key clinical question that prompted this study? And why is distinguishing between "intrinsic" and "extrinsic" dysfunction so critical for athletes?

Athletes usually have lower resting heart rates than sedentary individuals, and this has traditionally been attributed to increased vagal tone caused by exercise training. In other words, exercise shifts autonomic balance toward parasympathetic predominance, leading to bradycardia.

However, emerging experimental evidence suggests another possible mechanism: exercise-induced remodeling of ion channels within the sinus node itself. This means that the reduction in heart rate may not only depend on autonomic nervous system activity, but also on intrinsic electrophysiological remodeling.

The distinction is clinically important because extrinsic mechanisms are generally reversible. If an athlete stops training, the heart rate may return to normal within months. In contrast, intrinsic remodeling could persist even after the athlete’s career ends and may potentially contribute to long-term arrhythmic risk, including atrial fibrillation or conduction system disease.

That was the rationale behind our study—we wanted to better understand whether some athletes may continue to exhibit cardiac electrical abnormalities even after cessation of intensive training.

3. In your paper, when distinguishing between intrinsic and extrinsic nodal dysfunction, are there other non-invasive indicators that can assist in the assessment, such as high-density electrocardiography or the analysis of heart rate variability?

In clinical practice, current guidelines for differentiating benign from potentially pathological sinus bradycardia mainly rely on the response to exercise testing – an increase in heart rate during exercise suggests a benign vagal mechanism. However, if an intrinsic remodelling of ion channels exists, the heart rate may not increase as expected, and the athlete might remain healthy even after completing training. Other non‑invasive indicators, such as high‑density ECG or heart rate variability analysis, are not yet established tools for distinguishing intrinsic versus extrinsic mechanisms in this specific field. Further research is needed.

4. With the rapid development of AI in the field of cardiovascular risk prediction, do you see a potential for AI applications in screening arrhythmias in athletes?

Yes, absolutely. The most widely used tool for pre‑participation screening in athletes is the resting ECG – it is easy, quick, cheap, and widely available. However, its interpretation is challenging because many training‑induced ECG changes are benign but overlap with signs of diseases that cause sudden death. Distinguishing between them requires extensive training, which is uncommon. This reduces the effectiveness of screening and increases costs due to unnecessary additional testing. AI algorithms can be trained to better differentiate benign from pathological ECG patterns. AI could enable effective screening even in settings where expert interpretation is unavailable, thus expanding access and improving prevention.

5. You are a member of the Editorial Board of Reviews in Cardiovascular Medicine (RCM) and have also published several high-quality research articles in the journal. We would like to ask how you first came to be associated with RCM? What do you find most appealing about RCM?

I joined RCM a few years ago after being invited to become part of the Editorial Board. At that time, the journal was still relatively new to me, but over the years, I have come to appreciate its strengths. One of the most important aspects is that RCM is an open-access journal while still maintaining rigorous academic standards. Open access does not mean lower quality. Manuscripts undergo a thorough peer-review process before acceptance, and the editorial workflow is generally efficient.

Overall, I believe RCM provides an excellent platform for publishing high-quality cardiovascular research.

6. RCM has always emphasized a rigorous, open, transparent, and standardized peer-review mechanism. As an Editorial Board member, what criteria do you prioritize when reviewing manuscripts, and how do you assess the journal’s current peer-review quality?

Peer review today is very difficult because it relies on volunteers who dedicate their time without receiving any compensation in return. The main challenge is finding good reviewers – people who are experienced in the specific topic, have a solid scientific background, and can distinguish good from poor manuscripts. In any specialized topic, there may only be a handful of experts worldwide, and they are overwhelmed with review invitations. As editors, we cannot take any review assignment for granted. We need to re‑examine the manuscripts and sometimes invite additional reviewers if we are concerned about the quality and content. This increases the turnaround time, which authors dislike, but it is necessary. Balancing the huge number of submissions with the small pool of good reviewers is challenging for all journals, regardless of their impact factor.

7. What suggestions do you have for the future development of RCM in terms of the selection of topics, international visibility, and academic impact?

I believe physicians and researchers increasingly value practical and clinically useful articles. While original research remains essential for scientific progress, high-quality narrative reviews are also extremely important.

Narrative reviews should not only summarize the evidence but also provide practical guidance for clinicians, such as how to diagnose, manage, and follow up specific diseases. Including practical algorithms, images, or flowcharts could make these articles even more useful.

If RCM continues developing clinically oriented, high-quality content, it can further strengthen its international visibility and become an even more valuable resource for cardiovascular physicians worldwide.

We sincerely thank Associate Professor Alessandro Zorzi for his professional contributions and insightful perspectives. This interview offered valuable insights into the evolving field of sports cardiology, particularly regarding the mechanisms underlying athletes’ bradycardia and the future directions of cardiovascular screening. Prof. Zorzi’s views also underscored the importance of rigorous peer review, effective scientific communication, and interdisciplinary innovation in advancing cardiovascular medicine.

As an international open-access journal dedicated to cardiovascular medicine, Reviews in Cardiovascular Medicine will continue to promote high-quality academic exchange, support rigorous and transparent scientific publishing, and provide an influential platform for advancing cardiovascular research and clinical practice worldwide.

Journal Homepage: Reviews in Cardiovascular Medicine

Related Special Issue: Reviews in Cardiovascular Medicine