A list of all quality 4 items from The Binding of Isaac: Rebirth, ranked from best to worst. We combined votes from 62 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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Glitched Crown, Sacred Heart, Death Certificate
C Section, Mom's Knife, Twisted Pair, The D6, Sacred Orb, Godhead, R Key, Spindown Dice, Holy Mantle, Tech X, D Infinity
Brimstone
Incubus, Cricket's Head, Magic Mushroom, Psy Fly, Crown of Light, Pyromaniac, The Wafer, Binge Eater, Revelation, Mega Mush, Stop Watch, Flip
20/20, Polyphemus, Haemolacria, Void, Ipecac, Satanic Bible, Abyss, Dr. Fetus, Epic Fetus, Mega Blast
Mom's Shovel, Broken Shovel
