A list of all quality 4 items from The Binding of Isaac: Rebirth, ranked from best to worst. We combined votes from 58 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, Twisted Pair, The D6, Mom's Knife, Sacred Orb, R Key, Godhead, Holy Mantle, Spindown Dice, Tech X, D Infinity
Brimstone
Cricket's Head, Incubus, Crown of Light, Psy Fly, Magic Mushroom, Revelation, The Wafer, Binge Eater, Mega Mush, Pyromaniac, Stop Watch, Flip
Polyphemus, 20/20, Haemolacria, Ipecac, Void, Satanic Bible, Abyss, Dr. Fetus, Epic Fetus, Mega Blast
Mom's Shovel, Broken Shovel
