SUN-728 - Semaglutide-Associated Vestibular Dizziness Mimicking Symptomatic Mobitz Type 1 AV Block

Introduction:
Glucagon-like peptide-1 (GLP-1) receptor agonists are used in the management of type 2 diabetes mellitus and obesity with demonstrated effects on glycemic control and weight loss. While gastrointestinal adverse effects are well described, emerging data suggest possible neurologic or vestibular symptoms. In patients with underlying cardiac conduction disease, such symptoms can lead to diagnostic uncertainty.

Case Description:
A 70-year-old male with history of obesity and Mobitz type I second-degree atrioventricular (AV) block was re-admitted to the hospital for recurrent dizziness. During the prior admission 3 days ago, he underwent leadless pacemaker placement for suspected symptomatic Mobitz type I second-degree AV block. Despite pacemaker placement, he returned to the hospital for persistent dizziness described as “being on a boat”. Neurological exam was within normal limits. Labs showed glucose of 90 mg/dL (70-99 mg/dL). Computed tomography (CT) of the head and magnetic resonance imaging of the brain showed no acute intracranial abnormality. CT angiogram of the head and neck showed no large arterial occlusions or significant stenoses. Orthostatic vitals were negative. Neurology was consulted for persistent dizziness. Upon further review of history, the neurology team noted that the patient was on semaglutide for weight loss and recommended stopping semaglutide as it may be causing the dizziness. Upon further questioning, the patient endorsed taking a dose of semaglutide the day prior to the onset of initial dizziness during the previous admission. The patient’s dizziness resolved spontaneously on the seventh day since the last semaglutide administration. He was discharged with recommendation to stop taking semaglutide and for close follow up with a primary care doctor.

Discussion/

Conclusion:
This case highlights the diagnostic complexity of dizziness in patients with coexisting cardiac conduction disease and underscores the need to consider non-cardiac etiologies when symptoms persist despite appropriate device therapy. While pacemaker implantation was reasonable based on documented bradycardia and symptom of dizziness, persistence of symptoms with normal pacemaker function prompted reevaluation. In this case, the onset of dizziness coincided with semaglutide administration. Symptoms resolved seven days after the last dose, which is the estimated half-life of semaglutide. This case raises awareness of GLP-1 receptor agonists as a potential contributor to vestibular or neurologic symptoms and emphasizes the importance of comprehensive medication review prior to invasive interventions.

Reference:
Toraih EA, Alenezy A, Hussein MH, et al. The Risk of Vestibular Disorders with Semaglutide and Tirzepatide: Findings from a Large Real-World Cohort. Biomedicines. 2025;13(5):1049. Published 2025 Apr 26. doi:10.3390/biomedicines13051049

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