When Hand of Vecna enters the battlefield, sacrifice a creature. If you don't, you lose the game.
At the beginning of your upkeep, you lose one life, and put a charge counter on Hand of Vecna, and then destroy all creatures with toughness less than or equal to the number of charge counters on Hand of Vecna. They can't be regenerated. If, after doing this, there are no creatures in the battlefield, remove all counters from Hand of Vecna.