Declarer took the opening lead with the A in dummy, sluffing a club. (It's often wise to duck such a situation around to a ruff as declarer decides how best to use the A. But here there's no ambiguity about that, not to mention the wisdom of putting the lead in dummy for a trump finesse.) Declarer has to lose a diamond and a heart and hence cannot afford to lose a club. He's sluffed one. Can he generate another winner in dummy on which to sluff another? We'll see.
Declarer now took that diamond hook, pushing the 10 through to the A. And back came another spade, ruffed by declarer. Now at this point, declarer doesn't know whether East has a guard to the Q or not, nor does he know how hearts are splitting. But I would think the one thing he does know is that he must hang onto that A of clubs entry, the only certain one he has. An entry at the opportune time of having all trump out and established hearts is what's key to the hand.
Hence: declarer must either chance that East's Q of trump is now bare or that hearts are no worse than 4-2. You'll note that even if hearts are 4-2 and the hand with the A holds up one round, a third round attempt at giving partner a ruff won't come to anything. Declarer can overruff any ruff by East with impunity, and with a presumed proven finesse, could ruff with the J if the lead was from East through the closed hand.
But suppose the defense doesn't go for a third round ruff. Declarer still has the problem of the possibility that East's Q is guarded. What to do? Actually, there's no real problem here. For declarer has no choice if West holds up one round of hearts and reverts back to spades on winning the second round. On the basis of a bird in the hand is worth two in the bush, declarer must cash his K of trump and hope for the best. If he goes to dummy with the A of clubs instead of dropping the Q of trump, now East can kill a heart lead and prevent declarer from sluffing another club.
But suppose hearts were 3-3, and diamonds originally 3-1? Then declarer's best line is to go to dummy with the A of clubs, sluff a club on a heart lead and then continue the diamond hook. Yeah, yeah.
Well, now . . (years later) . . I think I missed a fairly safe line that only very unusual distribution would thwart. Declarer doesn't have to chance a now bare Q of trump, nor a defensive error. He must lead the Q of hearts, overtaking -- or low to the J (later overtaking, perhaps). If the defense takes the trick, declarer can protect the A of clubs by taking a club return in the closed hand, now go to dummy with a heart, take the trump finesse again, though the Q pops up, so there's no finesse, and now declarer can use that A of clubs to cash a last heart honor, sluffing a club.