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The new final boss in Wrath of the Lamb is Isaac himself, with three forms similar to The Devil.

As Isaac, I got to Utero, got through it, and beat It Lives, then go to Sheol and beat The Devil - I didn't see any way to get to another area or anything, and the game ended when I got the big chest after The Devil.

What do you have to do to get to Isaac?

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By the way, you get to the cathedral (where Isaac is) by stepping to light that appears next to the door to Sheol when you complete Utero or the Womb –  murgatroid99 May 29 '12 at 15:02
    
@murgatroid99 I don't recall seeing any light, but it's certainly possible that I missed it. –  Ian Pugsley May 29 '12 at 15:19
    
Right, I didn't mean that you had missed it, just that that's where you should look for it. –  murgatroid99 May 29 '12 at 15:21
    
To get to Sheol, did you use the Devil's room entrance or the It Lives one? Because in the It Lives room, after you beat him, you should find the usual trapdoor with a beam of light near it (similar to the death one); the trapdoor brings you, as usual, to Sheol, while the beam is the way to the Cathedral, with Isaac as the end boss. –  Kappei May 30 '12 at 14:24
    
@Kappei I used the trapdoor from the It Lives room, and didn't have a beam of light. I have since beat Isaac with Cain. –  Ian Pugsley May 30 '12 at 14:25
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2 Answers 2

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I've done many runs since the DLC came out, with different characters, never doing a challenge. Every time I killed It Lives, I've found both the trapdoor and the beam of light.

Every single time you finish the Womb, you should get the choice to go to Sheol or the Cathedral.

There is anyway a possibility that I just experienced: if a Demon Room Door appears after the fight, you'll find a chapel inside, with a trapdoor that brings you to the Cathedral. In this case you won't get the beam of light in the main room, only the trapdoor to Sheol. Yet, if you enter and exit the chapel, and the Demon Door disappears, you'll get both the trapdoor and the beam of light once again.

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@IanPugsley updated the answer with new informations –  Kappei Jun 4 '12 at 6:07
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if your doing a challenge run it will not show up

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So, not being in a challenge run is a necessary condition to fight Isaac. Is that the only condition? –  murgatroid99 May 29 '12 at 19:27
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