A list of all quality 4 items from The Binding of Isaac: Rebirth, ranked from best to worst. We combined votes from 45 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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Sacred Heart, Flip
Death Certificate, Glitched Crown, Twisted Pair, Spindown Dice, Crown of Light, C Section, D Infinity, Godhead, R Key, Polyphemus
Tech X, The D6, Pyromaniac, Revelation, Cricket's Head
Holy Mantle, Sacred Orb, The Wafer, Mega Mush, Stop Watch, 20/20, Psy Fly, Dr. Fetus, Ipecac, Epic Fetus
Magic Mushroom, Brimstone, Haemolacria, Mega Blast, Void, Satanic Bible, Mom's Shovel, Mom's Knife, Binge Eater, Incubus
Abyss, Broken Shovel
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