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Item: again, hard to say. There are several incredibly good items. Epic Fetus and Brimstone are amongst the best passives (once you know how to use them), but if you consider actives the Void has nice effects (hence why I replied Apollyon above) and D6 gives control over what you get... Don't get me started on synergies, most of the "meh" or "mostly bad" items can become incredible.
Item - D6
The best item in my opinion is Tech X, as i once did a full run with only that item. It's that good
Item - GodHead
Item-Tech X
Character - Azazel
Items - Mutant Spider, lots of DMG buff items(Cricket's Head, Pentagram, etc.), and Tammy's Head.
This one shots almost any boss. Only ones that survived this so far are It Lives!, Mega Satan, and Isaac/??? (It Lives! becomes bugged and can't attack if you drop him below 20% HP in that one attack. Mega Satan and Isaac/??? survive because they get invulnerability during certain parts of the fight)
Item: Sacred Heart
Character- Azazel
Item- Chocolate milk+Monstro’s lung+any damage increaser
Brimstone