Athame can be used to produce black hearts upon taking damage.Abaddon will give 2 black hearts on pickup, essentially refunding the cost to obtain the item from a Devil Room.Abaddon can be bought safely regardless of current health, because its price can be deducted from the acquired Black Hearts retroactively. Abaddon costs three Soul Hearts and grants six Black Hearts, damage up, fear shot, and no negative effects to ?. Birthright: Soul Hearts gained from health ups will be doubled.
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