Background The clinical benefit of cardiac resynchronization therapy (CRT) in heart failure patients with left bundle branch block (LBBB) has been demonstrated. However, a nonresponse rate of CRT nearly 1/3. Recent studies have reported left bundle branch pacing (LBBP) has achieved remarkable effect in CRT. This study aim to explore the efficacy and safety of LBBP in heart failure patients with LBBB. Methods We searched PubMed, Cochrane Library, Web of science, and CNKI databases for studies about LBBP in heart failure patients with LBBB. QRS duration (QRSd), New York Heart Association (NYHA) classification, B-type natriuretic peptide (BNP) concentration, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), pacing threshold and other related data were extracted and summarized. Results A total of 6 studies were included, and the success rate of LBBP was 93.2%. Compared with baseline, LBBP could shorten QRSd (MD = 61.23, 95% CI: 58.21-64.25, p < .01). Echocardiographic parameters including LVEF and LVEDD significantly improved (both with p < .01). Clinical outcomes including NYHA classification and BNP dramatically reduced (both with p < .01). Compared with biventricular pacing (BVP), LBBP could further improve QRSd, LVEF, LVEDD, and NYHA classification (all with p < .01). However, the pacing threshold at follow-up was 0.06 V higher than that at baseline (p < .01), and the incidence of complications was 2.4%. Conclusions LBBP is effective and safe in heart failure patients with LBBB, whether it is better than BVP needs to be verified by randomized controlled trials.