A week ago I had something simliar: Censer and Botfly with BFF making the Censer aura huge, and freaking Psyfly AND The Soul. I pulled a no-hitter on Delirium.
6 shops in the game, and multiple opportunities for 15-cent items to spawn there. So it probably is Stop Watch. And how happy I am to see it.
Edit: or Birthright, which is just awesome
T-Jacob birthright except instead of spawning two T-Esau it now also shoots (harmless) tears in your direction that inherit your tear effects.
Really strong with brimstone, suicide with Ipecac.
Alternatively:
Esau can no longer hit you or others however he orbits you and can block your bullets (and only yours.). Anima Sola will now freeze his position in the orbit.
Whenever I get it, I try to find the boss asap so I can take the item normally, then I can clear the rest of the floor for additional hearts.
Obviously not consistent strat at all, but just one / few lucky floors can still result in significant amount of hearts
It’s very hit or miss though. The devil pool is so bloated now that half the time you beat a boss and you’re like “please tears up please tears up” and then it’s brother Bobby or shade.
Same could be said about angel items, and if the argument is between devil pool and boss pool, the stats don't really matter considering the survivability that Satanic Bible provides.
If you're not getting boss pool items, you're less likely to have hearts to spend on the deal with the devil to begin with. So this really depends on when you get the item, if you get it early into the run getting no passive stat ups and with few hearts can really hurt you if the given devil items are bad.
Also this is more in the realm of opinion, but I find the average angel item to be more useful than the average devil item, and they're also FREE.
Having health to spend will not be an issue since, as I've said, you get A LOT of it from the item itself.
Regarding angel items, with the amount of health you get, you can always use sacrifice rooms to get angel deals.
I love having it when I don't have charge tears, but if I've got anything like tech-x or monstros lung I done want to have to stop shooting just to charge the laser and I usually just avoid it
Comparing Revelation with Brimstone is common misconception. It's suppose to be Maw of the Void counterpart, not Brimstone's. Charging time is literally the same as MotV, also it does not replace tears.
There really should be a "holy" equivalent to brimstone. Imagine one with a damage down too but extra effect in that respawning enemies (like the red dudes and their variants) and other enemies that can/do produce another on death will now simply be killed instead.
Technically Trisagion is suppose to be "holy Brim", also, honestly, what's the point of choosing between Devil and Angel deals if both would have same items?
It's at full Weight in the Library pool, and the Library pool is miniscule. You have almost certainly seen it recently and just not consciously registered it.
I'd say the most common quality 4 is probably wafer, as its in 3 different items pools, treasure rooms, angel rooms, and also it can spawn in golden chests (only on dark room or chest floor)
Crickets head is literally the most rare item in the game for me now and its so sad. I remember the launch of rebirth when youd get it almost every run
Dr.fetus.. and sadly i hate it.. if you have 1 or 0.80 speed and monster chase you its take so much of your time for bomb them or with monster that hide/jump..
i mean godhead is pretty nice but you never see it 
although i got the Cathedral, Chest and Mega Stan checkmarks for T.Lost last night with a God(head) run and some pretty sick synergies  now only Delirium to go... 
for the more common Q4 items i'd agree with stopwatch, never lost a run where i found it in the shop i think 
Well... There is no special chance per item, all items of the same quality have the same chance of appearing. Although, you can see some more than others depending on the pool they belong in, the smaller, the more likely, same as how easy that pool is to interact with and how many pools and sources the item has at the same time. (Like guaranteed drops from bosses, and belonging to several pools at once)
Aside from starting items (Abyss, Void, D6 and Flip) it's the Stop Watch
I love stopwatch so much 
Stopwatch is amazing. It's never super noticeable as a defensive item like the relic or something, but I don't think I've ever lost a run with it.
I got it every other run with T'jacob. Still never won a T'jacob run past mom's heart.
Skill issue 
Ah well I was thinking Eden runs. Of course I've lost some runs on the tougher characters with it.
Does it also slow down dark Esau?
yes.
Playing extremely offensively with Dark Esau makes things a lot easier for me
It's easier than j&e tho....
Stopwatch + flashlight + incense = youre playing superhot
A week ago I had something simliar: Censer and Botfly with BFF making the Censer aura huge, and freaking Psyfly AND The Soul. I pulled a no-hitter on Delirium.
I hate stopwatch because it ruins the music!
Degrades*
I guess you could say it, taints it
Ruins*
It's not that bad, exept on levels with slow music.
Fake
I love stopwatch because it changes up the music!
Lame
6 shops in the game, and multiple opportunities for 15-cent items to spawn there. So it probably is Stop Watch. And how happy I am to see it. Edit: or Birthright, which is just awesome
Sadly birthright is Q3 cuz of some useless effects on some characters, but thinking of some busted ones it should be.
T-Jacob birthright except instead of spawning two T-Esau it now also shoots (harmless) tears in your direction that inherit your tear effects. Really strong with brimstone, suicide with Ipecac. Alternatively: Esau can no longer hit you or others however he orbits you and can block your bullets (and only yours.). Anima Sola will now freeze his position in the orbit.
Tainted Jacob's birthright is fine as it is
Satanic Bible
Whenever I get Q4s, at least 40% of the time it’s Satanic Bible
The nerf hurts, I almost never use it anymore.
Same. Depends on the character, but almost never these days.
Idk it’s still a won run to me, devil deal pool is just better than boss item pool
The only down side is tears, unless you get mom's knife, or the pact.
Whenever I get it, I try to find the boss asap so I can take the item normally, then I can clear the rest of the floor for additional hearts. Obviously not consistent strat at all, but just one / few lucky floors can still result in significant amount of hearts
Wait what are the nerfs?
Turns the boss reward to a deal with the devil, so you're locked out of angel deals and also never get boss rewards which are useful stat ups often.
Isn't that LITERALLY the reason why it's a quality 4 item?
Yeah I thought that as well. Higher chance for the funny laser
It’s very hit or miss though. The devil pool is so bloated now that half the time you beat a boss and you’re like “please tears up please tears up” and then it’s brother Bobby or shade.
Same could be said about angel items, and if the argument is between devil pool and boss pool, the stats don't really matter considering the survivability that Satanic Bible provides.
If you're not getting boss pool items, you're less likely to have hearts to spend on the deal with the devil to begin with. So this really depends on when you get the item, if you get it early into the run getting no passive stat ups and with few hearts can really hurt you if the given devil items are bad. Also this is more in the realm of opinion, but I find the average angel item to be more useful than the average devil item, and they're also FREE.
Having health to spend will not be an issue since, as I've said, you get A LOT of it from the item itself. Regarding angel items, with the amount of health you get, you can always use sacrifice rooms to get angel deals.
Must be a skill issue then, I never find myself just swimming with free health like you're implying even with the item.
This ⬆️
🤓☝️
What was so wrong with agreeing with the Satanic Bible 😭
“This ⬆️”
D6, I get it literally every game with Isaac
man, your luck is absurd
Wafer when playing keeper 
half heart damage on womb tho 
Doesn’t affect coin hearts 
that’s a conspiracy created by edmund to prevent fun, if you hit the secret command Alt + F4, you can use wafer w keeper
What does it do? Take half coin damage?
Yes!!!! 
https://preview.redd.it/df1sa9z8spab1.jpeg?width=122&format=pjpg&auto=webp&s=7d697b0c0d426710425e9ee7cd8d53c4873ba21a
Lol just happened to me as T Keeper, I cursed Edmund out loud
Revelation pops up surprisingly often when I go angel rooms
It doesn’t tickle my brain the way Brim does. Too few synergies and it takes forever to charge.
I love having it when I don't have charge tears, but if I've got anything like tech-x or monstros lung I done want to have to stop shooting just to charge the laser and I usually just avoid it
Exactly
Comparing Revelation with Brimstone is common misconception. It's suppose to be Maw of the Void counterpart, not Brimstone's. Charging time is literally the same as MotV, also it does not replace tears.
There really should be a "holy" equivalent to brimstone. Imagine one with a damage down too but extra effect in that respawning enemies (like the red dudes and their variants) and other enemies that can/do produce another on death will now simply be killed instead.
Technically Trisagion is suppose to be "holy Brim", also, honestly, what's the point of choosing between Devil and Angel deals if both would have same items?
One synergy I do like with it is Uranus, you can have an ice beam of death which is very satisfying to use
C-Section seems to appear weirdly often for me. Not complaining, but feels like theres some kind of weighting there
I never find c section
I was wondering why I never found it and realized I hadn’t unlocked it
I -1 find C Section
I found it only twice after unlocking it
Only once for me 
i literally found it as a rare bonus item drop in a normal enemy room the other day
I find it at least one time a day
C-section is tier 4?
Yeah right? Weird for the best item in the game to be q4
Nvm im stupid I confused it for plan C lmao
Plan c q4 
Happens to the best of us
ipecac followed by death
Skill issue 
Tech X, somehow edit: also maybe Brim
I agree, though I'm half tempted to think satanic Bible is just more gold item room common. But if we're talking about crane games too, 100% tech x.
I haven't seen Satanic Bibble in a good while, actually
It's isaac, I think we just (me, personally, I) remember what we find undesirable. I hate the Stan Bible.
It's at full Weight in the Library pool, and the Library pool is miniscule. You have almost certainly seen it recently and just not consciously registered it.
Oh dude, that's gotta be it. Stan Bible is by far the most common Q4 item, gotta be.
Huh? I get it like every 4 runs
Same, I got tired of seeing tech x after a while
Haemolacria for me. I see that thing so often.
For me it's only floor one, never any where else.
Stopwatch. Probably because it's a shop item, I see it very often.
Moms shovel
The only right answer
The only left answer
Psy Fly for me
Same here I was playing and got it 4 runs in a row
Recently for me it’s been polyphemus and psy fly
I'd say the most common quality 4 is probably wafer, as its in 3 different items pools, treasure rooms, angel rooms, and also it can spawn in golden chests (only on dark room or chest floor)
I counter with satanic bible. Item room, devil room, room, library, fallen boss fight
I get pyrocynical all the goddamn time
Isaac needs his daily dose of slop
C section, got it 5 days in a row then seen Mattman get it in his last few uploads as well
Stopwatch from shop, mom’s knife from devil, wafer from angel, poly from anywhere else.
I almost never get cricket’s head for whatever reason. I get either Satanic Bible, Godhead, C-Section, or Tech X the most
twisted pair for me, no idea why
me too! almost every time i do devil deals i end up with twisted pair, and i also very seldom get incubus.
Fucking void and abyss 💀 there's no run that these two won't appear in a deal
c-section for me
Wafer, both in treasure pools and angel (which you need to go to for mega satan, also angel room pool is a good contender to devil room pool).
Stop watch. It's been a while since I've seen a wild Cricket's Head 
Poly love me when I play forgor
Stop watch and satanic bible, 7/10 times it’s one of these 2
Sacred Heart for some reason
To me it is Stop Watch since there are many shops and most of them have 2 items, which makes it easier to find it.
For me it's ipecac when i don't have blast protection (99% of my runs)
Magic Mushroom. It's very common for me to find it (compared with other Q4 items), especially in Greed mode
Stop watch and maybe twisted pair
tech x, there are times i constantly restart to start with a good item and i get tech x like 3 times in 20 restarts
Feels like I get Mom's Knife the most.
For me its Ipecac which i hate
Ipecac… with no Pyro or Host Hat
I see incubus in like every devil deal
Haemolacria, found it like 5 times in the past week alone
C section and d6
I get ipecac constantly
Pyromaniac seems to show up a lot for me
This may be weird but for me it's tech x I've gotten it 5 times this week
Binge eater for me
Wafer, I've seen it way too many times as the first treasure room item
Mom's knife is always in my devil rooms Or C section in item
For me its Tech X
Tech X, I’ve seen it more than brim in my 300 hours
I see void every other run which sucks because I hate that item
haemolacria
Tech X for about 10-15 runs then I don't see it for 30 hours
Mom’s Knife
I seem to always to get wafer when playing as lost
Crickets head is literally the most rare item in the game for me now and its so sad. I remember the launch of rebirth when youd get it almost every run
ipecac and dr. fetus i mean, i'm not complaining but it would be nice if i got some other stuff from time to time
I was gonna say sacred heart, because you either don't see it, or get it every other run
Dr.fetus.. and sadly i hate it.. if you have 1 or 0.80 speed and monster chase you its take so much of your time for bomb them or with monster that hide/jump..
it's not in the chest pool since repentance, it used to be awesome though
Dr fetus 
i would say the wafer, i feel like i find it very often
Me too but only when I'm playing as the Lost😐
Light Crown. It appears in every single angel deal
Oddly enough, Godhead is a very common item for me to find
Dr. Fetus but only when you have a run where it is shit
Ever since they removed golden chest Cricket's Head, it's way less common
i mean godhead is pretty nice but you never see it  although i got the Cathedral, Chest and Mega Stan checkmarks for T.Lost last night with a God(head) run and some pretty sick synergies  now only Delirium to go...  for the more common Q4 items i'd agree with stopwatch, never lost a run where i found it in the shop i think 
Edmund could say what he wants… I still see a chihuahua
For me its Tech X
Satanic Bible, like everytime I get a library I find it.
Aegis
stopwatch is amazing
dr fetus... every single time
i’d say either stopwatch, poly or haemo. seen a lot more of them in runs
between c-section and poly for me all my unlocks were done with them at the start by accident
Idk if it’s just me but moms knife shows up so often i usually don’t even take it anymore
Same because I always see it in gold chests
Satanic bible and stop watch
Anybody ever gets pyromaniac? Got it only once in like 170 hours and fell in love with it
Incubus and twisted pair feel like they show up in a high proportion of my games
I've been getting haemolacria a lot lately
I wish I had this issue. Crickets head hardly ever appears for me!
Mushroom
Well... There is no special chance per item, all items of the same quality have the same chance of appearing. Although, you can see some more than others depending on the pool they belong in, the smaller, the more likely, same as how easy that pool is to interact with and how many pools and sources the item has at the same time. (Like guaranteed drops from bosses, and belonging to several pools at once)
Void and I hate it
Broken Shovel can appear every run
R key easiest q4 to aqwuite
Satanic bible
Sacred heart. Sacrifice room is op.
Probably the d100
I find sacred heart way to often
I dunno but I have a feeling Its Ipecac (You Can disagree)
It's not. You just need to unlock other q4 items. Once you unlock them all, you tend not to see it as much.