A list of all quality 4 items from The Binding of Isaac: Rebirth, ranked from best to worst. We combined votes from 34 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.
Vote NowAll Votes
Sort by
Rating
Death Certificate, Sacred Heart
R Key, C Section, Brimstone, Glitched Crown, Twisted Pair, Sacred Orb, Godhead
The D6, Polyphemus, Spindown Dice, Cricket's Head, The Wafer, Mom's Knife, D Infinity, Tech X, Haemolacria, Incubus, Holy Mantle, Magic Mushroom, Crown of Light, 20/20
Pyromaniac, Revelation, Psy Fly, Ipecac, Stop Watch, Mega Mush, Dr. Fetus, Flip
Epic Fetus, Satanic Bible, Mega Blast, Binge Eater, Void, Abyss
Mom's Shovel, Broken Shovel
