What changed in The Binding of Isaac: Rebirth in 2020

Wisps spawned by the Book of Virtues can follow between rooms and have unique effects based on active items.

Soul hearts contribute to a 'soul charge' counter, allowing more aggressive use of active items.

Bethany is a new character with a unique gameplay style focused on soul hearts and a 'soul charge' mechanic.

Bethany starts with the Book of Virtues, which spawns a wisp familiar that can block shots and fires low damage tears.

The Dank Depths floor has been completely remade with added detail to enhance its mucky theme.

Characters like Blue Baby are receiving visual upgrades, including improved hair designs.

A new enemy that hops around spreading tar and creating messes on the battlefield.

The Whipper monster has received a visual upgrade.

A new variant of an existing enemy, now stickier and shares a mob mentality with other Butt Slickers.

Fistula has received a visual upgrade, enhancing its appearance.

Gemini has been visually upgraded with new details.

New Cathedral enemy that attacks players and forces movement to dodge other attacks.

New enemy type that jumps around the room, challenging players especially in groups.

Stationary enemy that protects others in the room, requiring players to focus on it first.

A new item returning from the anti-birth mod, featuring new combos.

A new item that reflects bullets and brimstone attacks when double tapping fire keys.

New holy and tainted enemies with unique graphics and attacks introduced in the cathedral.