Seems to be vsync-based. Would make the laundry pattern very hard at 360Hz :)
But why would vsync make that hard? You mean if it's 1:1 on the vsync?
If an enemy spawns e.g. a circle of bullets, you would see it rapidly expanding/contracting.
I suspect a variable frame rate bullet hell game would be harder to play, but I'm not a fan of the genre.
Games like Quake 3 do that, I think.