A list of all quality 4 items from The Binding of Isaac: Rebirth, ranked from best to worst. We combined votes from 49 players to create this list. Based on the latest version of The Binding of Isaac: Repentance. Quality is the game's internal tier list for items. Quality 4 is the highest tier, so these items are typically the most powerful.
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Death Certificate, Glitched Crown, Sacred Heart
Twisted Pair, Mom's Knife, The D6, Holy Mantle, Spindown Dice, C Section, Tech X, Godhead, Sacred Orb, R Key, D Infinity
Magic Mushroom, Brimstone, Incubus, The Wafer, Crown of Light, Cricket's Head, Binge Eater, Psy Fly, Revelation, Mega Mush, Pyromaniac, Stop Watch, Flip
20/20, Polyphemus, Abyss, Void, Ipecac, Haemolacria, Satanic Bible, Mega Blast
Dr. Fetus, Epic Fetus, Mom's Shovel, Broken Shovel
