•hERG primary anti-target responsible for serious side-effects.•hERG structure–activity relationships, data and models.•hERG channels structure and pathophysiology.•Testing screening methods and CIPA guidelines.•hERG target with a role in cancer. hERG is best known as a primary anti-target, the inhibition of which is responsible for serious side effects. A renewed interest in hERG as a desired target, especially in oncology, was sparked because of its role in cellular proliferation and apoptosis. In this study, we survey the most recent advances regarding hERG by focusing on SAR in the attempt to elucidate, at a molecular level, off-target and on-target actions of potential hERG binders, which are highly promiscuous and largely varying in structure. Understanding the rationale behind hERG interactions and the molecular determinants of hERG activity is a real challenge and comprehension of this is of the utmost importance to prioritize compounds in early stages of drug discovery and to minimize cardiotoxicity attrition in preclinical and clinical studies. We report how the understanding of SAR and the informed use of reliable data and models are pivotal to modulate the interplay with hERG channels.