A list of all quality 4 items from The Binding of Isaac: Rebirth, ranked from best to worst. We combined votes from 21 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, Sacred Heart
R Key, Brimstone, C Section, Glitched Crown, Sacred Orb, Godhead, Twisted Pair
Spindown Dice, Polyphemus, The D6, Magic Mushroom, Incubus, Mom's Knife, Crown of Light, Cricket's Head, Tech X, Haemolacria, D Infinity, The Wafer, 20/20, Holy Mantle
Revelation, Psy Fly, Pyromaniac, Mega Mush, Ipecac, Stop Watch, Flip
Dr. Fetus, Binge Eater, Satanic Bible, Epic Fetus, Mega Blast, Void, Abyss
Mom's Shovel, Broken Shovel
